Fall 2023
SEEKING
SOLUTIONS ARKANSAS HOSPITALS | FALL 2023 1
YOUR CHILD’S HEALTH IS A BIG DEAL. Arkansas Children’s is the state’s only health system built just for kids. By working within the communities we serve, it’s our mission to make children better today and healthier tomorrow. We are Champions for Children where they live, learn and play.
Our Promise: Unprecedented Child Health. Defined and Delivered. archildrens.org | 501-430-3142 2 FALL 2023 | ARKANSAS HOSPITALS
ARKANSAS HOSPITALS | FALL 2023 3
4 FALL 2023 | ARKANSAS HOSPITALS
SEEKING SOLUTIONS FEATURES
14 Shaping Rural Health Care 19 Heart Association Recognizes Hospitals 20 Focus on Workforce Wellness 22 Attracting the Best 31 Health Care Workforce Solutions 34 Building a Workforce Pipeline 39 CMS Announces Five-Star Ratings 44 Augmenting Patient Care 46 The Capitol Report
IN EVERY ISSUE
7 President’s Message 9 Editor’s Letter 10 Event Calendar 12 Hospital Newsmakers 26 Leader Profile: Brian Thomas 37 AHA Services Presents 41 Coach’s Playbook 50 Where We Stand: Workforce By the Numbers
Arkansas Hospitals is published by The Arkansas Hospital Association
419 Natural Resources Drive | Little Rock, AR 72205 To advertise, please contact Brooke Wallace magazine@arkhospitals.org Ashley Warren, Editor in Chief
Nancy Robertson, Senior Editor & Contributing Writer Mike Spain, Graphic Designer
Roland R. Gladden, Advertising Traffic Manager
BOARD OF DIRECTORS
Ron Peterson, Mountain Home / Chairman
Larry Shackelford, Fayetteville / Chairman-Elect Peggy Abbott, Camden / Treasurer
Chris Barber, Jonesboro / Past-Chairman
Ryan Gehrig, Fort Smith / Director, At-Large Greg Crain, Little Rock David Deaton, Clinton Phil Gilmore, Crossett
James Magee, Piggott
Guy Patteson, Jonesboro Gary Paxson, Batesville Eric Pianalto, Rogers
Judy Shaffer, Mountain Home Brian Thomas, Pine Bluff Debra Wright, Nashville
EXECUTIVE TEAM
Robert “Bo” Ryall / President and CEO Jodiane Tritt / Executive Vice President Tina Creel / President of AHA Services, Inc. Pam Brown / Vice President of Quality and Patient Safety Lyndsey Dumas / Vice President of Education Debbie Love / CFO
FALL 2023
DISTRIBUTION: Arkansas Hospitals is distributed quarterly to hospital executives, managers and trustees throughout the United States; to physicians, state legislators, the congressional delegation, and other friends of the hospitals of Arkansas. Arkansas Hospitals is produced quarterly by Central Arkansas Media. Periodicals postage paid at Little Rock, AR and additional mailing offices. The contents of Arkansas Hospitals are copyrighted, and material contained herein may not be copied or reproduced in any manner without the written permission of the Arkansas Hospital Association. Articles in Arkansas Hospitals should not be considered specific advice, as individual circumstances vary. Products and services advertised in the magazine are not necessarily endorsed by the Arkansas Hospital Association. To advertise, email magazine@arkhospitals.org.
ARKANSAS HOSPITALS | FALL 2023 5
Plus, enjoy earning
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on your business checking account!
PRESIDENT’S MESSAGE
Finding Solutions
H
ospitals are constantly adjusting to new situations, new challenges, and new methods of health care delivery. When I consider the many adjustments every Arkansan made to deal with this summer's extreme heat, I'm only more amazed by the daily adjustments our hospitals accomplish in today's challenging economic environment. We all admire our hospitals for their agility, and we applaud their approaches to today’s workforce and financial crises. Finding new ways of doing business while reducing costs takes creativity and commitment. We know that hospitals throughout Arkansas and across the U.S. are looking for ways to trim expenses while retaining the services their communities need. Different models of care are emerging, offering the chance to think outside the box and find new answers to some very tough business questions. One of these new models is the Rural Emergency Hospital (REH). This model was created to respond to the increasing number of rural hospital closures, giving rural communities options for how to maintain access to health care. When an eligible facility converts to an REH, it is allowed to provide emergency department services, observation care, and additional outpatient medical and health services that do not exceed an annual per patient average length of stay of 24 hours. St. Bernards Five Rivers Medical Center is the first in the state to make this conversion. Other new models of care are emerging around the issue of workforce. The current (and ongoing, if predictions are accurate) shortage of health care professionals is causing hospitals to find new
ways to attract and retain a strong workforce. One outcome of the severe shortage is hospitals’ outreach to collaborate in the creation of a viable workforce pipeline for the future. Hospitals across the state are coming up with new ideas that suit each community’s needs and resources. You can read about some of these solutions in this edition of Arkansas Hospitals. Now that we've moved out of the heat wave, our thoughts are turning to Fall and - what else? Football! I am excited to welcome Boomer Esiason to Arkansas this November, when he will deliver the keynote address for this year’s AHA Annual Meeting. I’ve followed Boomer’s career since he played college ball in Maryland, then professionally with the Cincinnati Bengals and the New York Jets. For years, we’ve enjoyed his expertise as a football analyst, most recently for CBS Sports. In his keynote address, we’ll learn about another side of Boomer. He has faced unbelievably tough challenges in life, and he will share with us his insight into how to overcome adversity and achieve resilience. I hope you’ll join us for this year’s Annual Meeting, November 1-2. Health care experts with an array of specialties will present the latest in confronting today's challenges, and we know you'll come away with tools you can use in your own organization every day. Whether it’s beating the heat, filling workforce needs, or finding new care delivery models, we know Arkansas hospitals are leading the way with solutions for their communities. We hope you enjoy reading about some of their innovations here, and we hope to see you at the Annual Meeting in November.
Bo Ryall
President and CEO Arkansas Hospital Association
ARKANSAS HOSPITALS | FALL 2023 7
What does it mean to be taken care of? At Arkansas Blue Cross and Blue Shield, it means providing peace of mind. We’ve been taking care of Arkansans for over 70 years, providing affordable, reliable health insurance … to keep Arkansans healthy and to help them heal. We’re investing in communities to keep this diverse and wonderful state strong. We’re committed to a whole person approach to health, including physical and behavioral well-being. And we recognize that total health is influenced by many factors, including medical history, genetics, lifestyle, environment, nutrition, safety and physical activity. We also realize that it will take all healthcare providers working together to ensure future generations of Arkansans can live their best life their whole life long. Let’s take good care, Arkansas.
8 FALL 2023 | ARKANSAS HOSPITALS
EDITOR’S LETTER
In All Seasons T
his time of year, it seems every Arkansan belongs to one of two camps: There are the “pumpkin spicers,” who have rushed right into fall flavors, fashion, and décor despite the fact that temperatures recently broke 100° on multiple days; and there are the “temperature truthers,” who are high fiving over the fact that shorts and sandals are now discounted everywhere, and we will comfortably be wearing them well into November. But, while we can’t agree on whether it’s summer or fall, we can agree that it’s football season … by which I really mean that Boomer Esiason is presenting the keynote address at this year’s Annual Meeting! I'm excited to see how Boomer's personal experiences can give our hospitals new ideas to apply to their greatest obstacles and show them how he has moved through his own life with resilience and courage during times of adversity. At this Annual Meeting, together we'll seek solutions to today's most pressing health care challenges. In this edition of Arkansas Hospitals, we introduce you to several of the many ways hospitals are meeting workforce challenges, one of the toughest issues currently faced by the health care world. You’ll find out how Unity Health is using its Medical Residency Program to train physicians in the rural setting, hopefully encouraging these young physicians to stay with rural medicine and settle down in Arkansas. You’ll meet leaders at UAMS who are at the forefront of recruitment and
retention efforts, focusing on the needs of health care workers with innovative programming. You’ll get to know Jefferson Regional’s CEO, Brian Thomas, who from his first day leading the hospital put his main focus on employee health, well-being, and communication. On the national side of workforce solutions, we present highlights from the American Hospital Association’s 2023 Workforce Scan, which pinpoint where today’s troubles lie and suggests new ways of thinking simultaneously about present and future workforce needs. And we are providing access to an important piece that gives tips on how to build the workforce of the future from within our own communities. AHA’s Executive Vice President, Jodiane Tritt, summarizes the health care-related actions taken in this year’s legislative session – always a factor as hospitals seek solutions for not just keeping their doors open but also for thriving. We are committed to bringing you stories from hospitals throughout the state that illustrate how truly dedicated they are to finding solutions to significant challenges, adapting to ever-changing conditions, and to always improving the quality of care they provide to patients. But hospitals can’t serve without the communities that support them, and as a reader of this magazine, you are a part of that support system. We at Arkansas Hospitals appreciate your constant engagement and enthusiasm for exploring, learning about, and celebrating the extraordinary work of our hospitals – in all seasons.
Ashley Warren Editor in Chief
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2023 Fall Calendar OCTOBER
October 5
Arkansas Hospital Association Workers’ Comp Self-Insured Trust (AHAWCSIT) 2023 Annual Education Conference AHA Classroom
October 12
AHA Series How to Have Tough Conversations in Healthcare Virtual event
October 13
Society for Arkansas Healthcare Purchasing and Materials Management (SAHPMM) 2023 Fall Conference Conway Regional Medical Center
Arkansas Association for Healthcare Quality (AAHQ) Education Conference Virtual event
October 17
340B Quarterly Meeting Virtual event
October 18
AHA Services Webinar Bridging Gaps: Medicare’s CCM and Social Determinants ChartSpan Webinar
NOVEMBER
November 1-2
Arkansas Hospital Association 2023 Annual Meeting Little Rock Marriott
November 1
AHA Board Meeting Held in conjunction with the AHA Annual Meeting Little Rock Marriott
November 1
Arkansas Hospital Auxiliary Association (AHAA) Board Meeting Held in conjunction with the AHA Annual Meeting Little Rock Marriott
November 3
Arkansas Association for Healthcare Engineering (AAHE) 2023 Scholarship Trust Trap Shooting Tournament Jacksonville
November 9
AHA Series Workforce Development: A Strategic Approach Virtual event
November 15
AHA Services Webinar New Emergency Management Compliance from The Joint Commission HSS Webinar
DECEMBER
December 7
Arkansas Hospital Association Workers’ Comp Self-Insured Trust (AHAWCSIT) Board Meeting Virtual event
December 20
AHA Services Webinar On the Road to Recovery: Confronting Physician Burnout, Recruitment, and Retention JPS (Jackson Physician Search) Webinar 10 FALL 2023 | ARKANSAS HOSPITALS
OPIC 2 – Arkansas Ballroom
ARD MEETING Past, Present, and Future of Nurse-led Innovation
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Register Online Now For The Arkansas Hospital Association 2023 Annual Meeting
session will describe how nurses are transforming health care and discuss their power to eobby healthLevel care’s future. It will define “nurse innovation,” discuss historic nurse innovators, tify key themes of how to cultivate a culture of innovation in health care, and discuss telythinking following gn and innovation processes and how they relate to health care.
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LEADERSHIP WORKSHOP Phil Gwoke
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Panel Discussion: War Stories from the Defense Bar
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ARKANSAS HOSPITALS | FALL 2023 11
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HOSPITAL NEWSMAKERS Rick Naegler has been named CEO at Northwest Medical CenterSpringdale and Market CEO of Northwest Health. He formerly served as Chief Executive Officer of Poplar Bluff Regional Medical Center in Poplar Bluff, Missouri, and as CEO, COO, and CNO at various hospitals in the state of Florida. He earned his master’s degree in health care administration from Bellevue University in Bellevue, Nebraska.
A ribbon cutting for the new UAMS Radiation Oncology Center was held in mid-July, marking the opening of the $65 million, three-level, 58,000 square foot facility. The center is the only cancer center in Arkansas to offer Ethos Adaptive Therapy, a form of X-ray radiation that adapts to daily changes in a tumor’s shape and position over the course of treatment. The center is a part of the Winthrop P. Rockefeller Cancer Institute.
Barry Davis, FACHE, CEO/President of Arkansas Methodist Medical Center in Paragould, has announced his retirement after a 42-year career with the hospital. His roles at the hospital grew from Plant Manager to Credit Manager, to Vice President of Operations to CEO/President, a role he has held since 2012. He is a recipient of the American College of Healthcare Executives Regent’s Award, and he served for many years as a member of the AHA Board of Directors. The University of Arkansas for Medical Sciences (UAMS) is the first organization in the state to earn The Joint Commission’s Gold Seal of Approval for Certification in Spinal Fusion. This certification is awarded to health care organizations with protocols proven to deliver better outcomes within a practice specialty – in this case, spinal fusion. Tony Thompson, MSHCA, FACHE, is the new CEO at Izard Regional Hospital, LLC. He formerly served as principal/founder with Thompson Healthcare Consulting, LLC, and prior to that served as CEO at hospitals in Kansas. He formerly served as CEO at Fulton County Hospital and as Facilities Administrator at White River Medical Center in Batesville. He earned his master’s degree in health/health care administration/ management from the University of Mississippi.
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The UAMS Milk Bank, the first facility of its kind in Arkansas, opened September 6. It will help ensure a ready supply of donor milk for sick and vulnerable infants in neonatal intensive care units in Arkansas, shortening the time it takes for regional hospitals to receive critical milk supplies and improving outcomes for babies. Previously, Arkansas hospitals relied on donor milk purchased from milk banks in other states. Mary Daggett, FACHE, MBA, MCD, CPHQ, has been named CEO for Jefferson Regional Specialty Hospital, a new rehabilitation and behavioral hospital currently being built in White Hall. She earned her master’s in business administration from the University of ArkansasLittle Rock and her master’s in communication disorders from Our Lady of the Lake University in San Antonio, Texas. The 76-bed facility is a joint venture of Jefferson Regional and Lifepoint Rehabilitation, a division of Lifepoint Health.
North Arkansas Regional Medical Center recently donated a variety of essential medical equipment including hospital beds, wheelchairs, walkers, hampers, and supplies for daily patient care to the new Harrison High School Certified Nursing Assistant Program. The equipment will be used to help students develop practical skills that closely mirror those performed in a hospital setting, and the donation is described as one tool for assisting health care education and workforce development in the region.
The UAMS Department of Emergency Medicine recently received a $1.5 million grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The grant will fund a threeyear project to educate and train UAMS emergency physicians, emergency medicine residents, advanced practice providers, and nurses about pain management strategies that treat pain aggressively but don’t rely on opioid medications. Kevin Burton, MBA, has been named Administrator of Unity Health - Jacksonville. He is a longtime member of the Unity Health team, where he has served as both Director – Internal Audit and Director – Patient Financial Services. He earned his Bachelor of Business Administration, Accounting, and his Master of Business Administration from Harding University, where for a time he also served as an adjunct professor.
A new scholarship fund will assist students at the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University. Established by the Mary Ann and Sidney Arnold Foundation, the scholarship will cover a portion of tuition for students who are from select Arkansas Delta counties and who have expressed interest in remaining in the area to practice medicine once they complete their training. St. Bernards Five Rivers Medical Center adopted the newly established Rural Emergency Hospital (REH) designatin September 1. It is the first hospital in the state to convert to REH designation, which allows hospitals with no more than 50 beds to remain viable by limiting inpatient care to 24 hours or less and, instead, focusing on providing 24/7 emergency services and observation care. Patients requiring inpatient care, under the REH protocols, are transferred to inpatient facilities.
Washington Regional Medical Center’s emergency department is the first in Arkansas to earn the Emergency Nurses Association Lantern Award® and one of only 53 in the world this year to receive the distinction, which recognizes emergency departments that exemplify exceptional and innovative leadership, practice, education, advocacy, and research.
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SOLUTIONS
Shaping Rural Health Care through Unity Health’s Residency Program By Leslie Provence, Director of GME Operations, Unity Health
O
ne hundred and thirty-nine thousand doctors. That’s the predicted physician shortfall the United States will face by the end of 2023, according to the Association of American Medical Colleges. This alarming projection is a major concern for hospitals everywhere. But for rural areas, which are disproportionately affected by physician shortages, the concern is becoming a crisis.
A RURAL CRISIS
Data and experience tell us that top-performing physicians often gravitate toward urban and suburban centers, leaving rural and underserved communities struggling to attract medical professionals who can provide even the most basic of health services. With a growing deficit of rurally based physicians, especially those practicing in specialty services, people who live in rural communities often must travel for care – sometimes many hours, roundtrip – for something as simple as a visit to their family practitioner. How is access to health care feasible for rural residents who may lack reliable transportation, who may not be able to take a day off from work, whose family depends upon their role as the sole financial provider, or who don’t have the disposable income necessary to pay for childcare? What if the patient is dealing with a high-risk pregnancy that requires frequent OBGYN visits or is navigating a cancer diagnosis that requires three weeks of daily radiation treatments? 14 FALL 2023 | ARKANSAS HOSPITALS
Dr. Dewey McAfee
These socioeconomic barriers further compound the issue, making access to health care a true quality-of-life issue for rural residents. With 41% of Arkansans living in rural counties, the physician shortage and its disproportionate impact on rural communities underscores an urgent need for innovative solutions to bridge this gap. It’s important to ensure that all Natural State
residents receive timely and adequate medical care, regardless of their location. The mounting crisis is something we can’t afford to ignore, and it is something those of us engaged in health care must do everything in our power to correct. Through our Ray Montgomery Department of Graduate Medical Education, Unity Health, based in Searcy, aims to tackle this crisis head on. With the state’s second largest Graduate Medical Education (GME) program, Unity Health is playing a crucial role in training new physicians and addressing the pressing issue of physician shortages, especially in rural settings.
ONE SOLUTION: PARTNERSHIP WITH MEDICAL SCHOOLS
With its founding in 2014, the Arkansas College of Osteopathic Medicine (ARCOM) sought partners to help train medical students and future physicians and to help meet Arkansas’s
with ARCOM to help train the school’s thirdand fourth-year medical students and to offer graduates GME training as resident physicians. “While we know that not all of our residents will remain in Arkansas after residency, affiliating with an Arkansas medical school is an additional way we can work to provide additional physicians for our state,” says Dr. Dewey McAfee, Designated Institutional Officer for Unity Health’s GME program. Today, Unity Health offers five residency programs, including emergency medicine, family medicine, internal medicine, psychiatry, and a transitional year offering. Our GME program currently trains an average of 104 residents each year. The residents of today are not only from ARCOM but also come from other medical schools across the state, the U.S., and around the world. Unity Health President and CEO Mark Amox emphasizes the fact that the residency program focuses on collaboration and partnerships with other Arkansas medical institutions, including the University of Arkansas for Medical Sciences (UAMS), Arkansas Children’s Hospital (ACH), the Conway Regional Physician Hospital Organization, and CHI St. Vincent hospitals – as well as outpatient physician clinics in Little Rock and Conway. “By working in tandem with other organizations, Unity Health is actively involved in shaping medical education and training future physicians,” he says. “These intentional collaborations ensure that medical curricula are aligned with the needs of all Arkansans and that physicians are equipped with the skills required to navigate the state’s unique challenges.”
A GROWING PROGRAM
Mark Amox
needs for more health care professionals. In 2019, ARCOM entered pre-accreditation with the Higher Learning Commission, an institutional accreditation agency recognized by the U.S. Department of Education, and it achieved initial accreditation in June of 2021. Unity Health, in support of the state’s growing medical school community, partnered
Why is Unity Health’s residency program growing so rapidly? Situated in the heart of White County, Unity Health is among the state’s most comprehensive rural, not-for-profit health systems. The system includes four hospital campuses in three markets – Searcy, Newport, and Jacksonville – and it is home to more than 20 physician clinics and specialty centers serving eight rural Arkansas counties. Receiving their post-graduate training in these rural communities offers Unity Health resident physicians a taste of serving an underserved area – in some cases, after residency, these physicians may serve rural communities as the sole physician practitioner. ARKANSAS HOSPITALS | FALL 2023 15
Collaborative care is a team effort in the Unity Health Residency Program.
Excellent patient care is the top priority in the Unity Health GME program.
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Medical residents in the Unity GME program are given direct, hands-on opportunities, including the delivery of babies while on their OB-GYN rotation or assisting in saving lives in the Unity Health Newport and Unity Health Searcy hospital emergency departments. Unity Health’s service area welcomes patients from communities as large as Searcy and as small as Garner: population 216. Medical residents soon learn that serving Unity Health’s rural patients offers them valuable learning experiences and unique challenges. As we have noted, too often, rural patients struggle with access to health care, and they
may experience socioeconomic barriers that cause various delays in seeking care. A patient’s lack of health literacy can also cause them to delay care or forego medical care altogether. Any or all of these causes of delay can mean the physicians treating them are sometimes diagnosing conditions after their disease enters a more advanced, critical stage. These dire circumstances give Unity Health resident physicians firsthand experience with cases they may have previously only read about in textbooks or heard about in a classroom. “Our patients often don’t go to the doctor unless they feel like they’re dying,” says Dr. McAfee, who also serves as the family medicine residency program director at Unity Health. “This allows our residents to see pathology they may not have seen elsewhere.” It also allows them to develop their skills of listening and compassion when patients present with acute illness. We believe that another reason Unity Health’s GME program is so popular is the system’s inclusion within the Mayo Clinic Care Network. This presents a huge draw for residents focused on the oncology rotation. The connection to the Mayo Clinic provides physicians and those residents training under them with access to one of the nation’s premier oncology clinics. Unity Health just hired oncologist and hematologist Dr. Neelakanta Dadi, who will also serve as the subspeciality education coordinator for the internal medicine program. He will work with family and internal medicine program residents to treat patients with cancer and blood disorders. The hospital’s psychiatry program, which offers outpatient and inpatient services for adolescents to geriatric patients, is the top-matching program within the GME department. It has consistently matched 100% of its available residency spots for the past six years.
COMMUNICATION AND HEALTH LITERACY
Unity Health’s residency program places great emphasis on communication – an essential element of physician effectiveness and credibility. Educational disparities sometimes found in rural communities can lead to a lack of health literacy among patients. Unity Health’s resident physicians learn to diagnose and treat medical conditions while clearly communicating their patients’ conditions to both the patient and to their family members. Always protecting the patient’s dignity is key, and acquiring vital communication skills to bridge the gap between medical knowledge and a patient’s understanding is a major part of providing care. GME residents learn how to effectively communicate complex medical concepts in ways that are accessible and understandable to patients with varying levels of education, a skill that enhances patient-doctor relationships and empowers patients to take an active role in managing their own health.
health. It reduces the burden on existing health care facilities, decreases patient wait times, and enables individuals to seek preventive care and early interventions. While Unity Health’s residency program continues to grow, it represents a significant value to rural Arkansas and to the state as a whole – especially when residency graduates choose to stay in the Unity Health system and in the state of Arkansas. “We must be diligent in our efforts to provide more underserved communities with the local health care needed,” Amox says. “We can all create better access by leaning in to encourage and equip new physicians to
BECOMING ENTRENCHED IN THE COMMUNITY
An added element of training in a rural hospital setting is the emphasis on community – of people living with close connections to one another. When physicians train in smaller communities, it’s possible to form deep, lasting connections and to invest in the longterm well-being of their patients. “This level of familiarity tends to create a stronger relationship than the typical physician-patient connection,” says Dr. McAfee. “We can be more friendly, empathetic, and have a closer understanding of their health picture. Even when I send patients to specialists, they return to talk to me before proceeding with care. That’s not because of a distrust of the specialist but because we’ve built this level of trust that they need to feel comfortable [when making major] health care decisions.”
A VISION FOR THE FUTURE
The presence of well-trained physicians in rural areas can profoundly impact community
serve in those rural and vulnerable areas. At Unity Health, our goal is to train and inspire future physicians to live and work in Arkansas.” Through its commitment to education, collaboration, and community engagement, Unity Health is not simply training physicians – it is helping shape the future of health care in rural Arkansas and beyond. As the nation continues to grapple with the physician shortage crisis, Unity Health serves as a beacon of hope, demonstrating that innovation and dedication can be a powerful tool in addressing the nationwide physician shortage and improving health care in rural communities.
Unity Health White County Medical Center
ARKANSAS HOSPITALS | FALL 2023 17
INVITING STUDENTS TO CONSIDER HEALTH CARE CAREERS
I
n addition to its residency training program, Unity Health provides educational opportunities for high school students, hoping to spark an interest in medical careers before they move on to higher education. “It’s important that we swim upstream to capture the hearts and minds of today’s students early in their education to provide a clear understanding of health care careers and inspire a passion for this field of study,” says Mark Amox, Unity Health President and CEO. “They are the future of our industry.”
UNITY HEALTH ACADEMY OF HEALTH SCIENCES
In August, The Academies of Central Arkansas announced the establishment of the Unity Health Academy of Health Sciences at Jacksonville High School. The academy results from a partnership between Unity Health, Jacksonville High School, and the Jacksonville North Pulaski School District. This partnership will provide students with tools to succeed beyond high school and positively impact education within the county. Throughout their four years at Jacksonville High School, students in the Unity Health Academy of Health Sciences will benefit from enhanced learning opportunities. Beginning in the 2023-2024 school year, students will participate in health care industry field trips, job shadowing, career mentoring, mock interviewing, and potential internship or externship opportunities. If a student is nearing graduation from the Unity Health Academy of Health Sciences program, they will also have the opportunity to earn a concurrent credit, industry-
recognized credentials, and the ability to create a capstone project co-developed by a team at Unity Health and the faculty at Jacksonville High School.
CAMP: SUMMER TRAINING PROGRAM
Each summer, Unity Health’s CAMP (Careers and Medical Professions) program welcomes 16 high school juniors and seniors for a week of hands-on exploration of the health care field. The students tour medical departments within Searcy’s White County Medical Center and specialty care clinics, and they engage with guest speakers from the health care community and enjoy exclusive shadowing Delaney Giles experiences. The program concludes as students participate in coordinated community disaster drills, experiencing how the health care community reacts in times of crisis. “We love welcoming students who are eager to learn more about our field,” says Delaney Giles, Health CAMP director. “It’s so rewarding to hear all they have learned in just a few short days.” The five-day summer program is free and open to high school juniors and seniors interested in exploring health care careers. For more information, visit https://www.unity-health. org/resources/unity-health-camp/.
We love welcoming students who are eager to learn more about our field. It’s so rewarding to hear all they have learned in just a few short days. 18 FALL 2023 | ARKANSAS HOSPITALS
A
AMERICAN HEART ASSOCIATION RECOGNIZES ARKANSAS HOSPITALS FOR HEART ATTACK AND STROKE TREATMENT
rkansas hospitals are among those being recognized for their commitment to following upto-date, research-based guidelines for the treatment of heart disease and stroke, ultimately leading to more lives saved, shorter recovery times, and fewer readmissions to the hospital. The American Heart Association’s Get With The Guidelines® and Mission: Lifeline® awards are hospitalbased quality improvement recognition programs that use the latest evidence-based scientific guidelines to save lives and hasten health care recovery times. Through these programs, the American Heart Association recognizes participating hospitals for
demonstrating their dedication to improving quality care and reducing barriers to prompt treatment. Get With The Guidelines® and Mission: Lifeline® award categories cover treatment for stroke, high cholesterol, cardiac arrest, heart failure, ST-elevation myocardial infarction heart attack, Type 2 diabetes, and atrial fibrillation. Award levels range from Gold Plus to Bronze status, depending on the number of requirements met for each designation. In general, Bronze recognizes performance of 90 consecutive days, Silver recognizes performance of 12 consecutive months, and Gold recognizes performance of 24 consecutive months.
2023 Arkansas hospital gold, silver, and honor roll recognitions include: BATESVILLE White River Health System STEMI: Gold Receiving BENTONVILLE Northwest Medical Center Bentonville Target: Type 2 Diabetes Honor Roll and Get With The Guidelines® Stroke Gold Plus CAMDEN Ouachita County Medical Center Target: Stroke Honor Roll Elite and Get With The Guidelines® Stroke Silver Plus CONWAY Baptist Health Medical Center-Conway Target: Type 2 Diabetes Honor Roll, Get With The Guidelines® Stroke Gold Plus, Target: Stroke Honor Roll Conway Regional Medical Center Target: Type 2 Diabetes Honor Roll, Target: Stroke Honor Roll Elite, Get With The Guidelines® Stroke Gold Plus, STEMI: Gold Plus Receiving, Get With The Guidelines® Heart Failure Silver DARDANELLE Dardanelle Regional Medical Center STEMI: Silver Plus Referring FAYETTEVILLE Washington Regional Medical Center Target: Stroke Honor Roll Advanced Therapy, Target: Type 2 Diabetes Honor Roll, Target: Stroke Honor Roll Elite Plus, Get With The Guidelines® Stroke Gold Plus, NSTEMI: Silver, STEMI: Silver Plus Receiving FORT SMITH Baptist Health-Fort Smith Get With The Guidelines® 10-Year Gold Plus, Target: Type 2 Diabetes Honor Roll, Get With The Guidelines® Heart Failure Gold Plus, Get With The Guidelines® Stroke Gold Plus, Target: Stroke Honor Roll, Target: Heart Failure Honor Roll
Mercy Hospital-Fort Smith Target: Type 2 Diabetes Honor Roll, Target: Stroke Honor Roll Elite, Get With The Guidelines® Stroke Gold Plus HARRISON North Arkansas Regional Medical Center STEMI: Silver Plus Referring HOT SPRINGS CHI St. Vincent Hot Springs Target: Type 2 Diabetes Honor Roll, STEMI Gold Receiving, NSTEMI Gold, Get With The Guidelines® Stroke Gold Plus JONESBORO NEA Baptist Memorial Hospital Target: Type 2 Diabetes Honor Roll, Target: Stroke Honor Roll Elite, Get With The Guidelines® Stroke Gold Plus St. Bernards Medical Center Target: Type 2 Diabetes Honor Roll, Target: Stroke Honor Roll Elite, NSTEMI: Gold, STEMI: Gold Plus Receiving, Get With The Guidelines® Stroke Silver Plus LITTLE ROCK Baptist Health Medical Center-Little Rock Target: Type 2 Diabetes Honor Roll, Target: Stroke Honor Roll Elite, Get With The Guidelines® Stroke Gold Plus UAMS Get With The Guidelines® 10-Year Gold Plus Recognition, Target: Type 2 Diabetes Honor Roll, Target: Stroke Honor Roll Elite, Get With The Guidelines® Stroke Gold Plus
POCAHONTAS St. Bernards Five Rivers Medical Center Target: Stroke Honor Roll Elite, Get With The Guidelines® Stroke Gold Plus, STEMI: Gold Plus Referring ROGERS Mercy Hospital Rogers Target: Type 2 Diabetes Honor Roll, Target: Stroke Honor Roll Elite, Get With The Guidelines® Stroke Silver Plus RUSSELLVILLE Saint Mary’s Regional Medical Center Target: Type 2 Diabetes Honor Roll, Target: Stroke Honor Roll Elite, Get With The Guidelines® Stroke Gold Plus SALEM Fulton County Hospital STEMI: Silver Referring SHERWOOD CHI St. Vincent Medical Center North Target: Stroke Honor Roll Advanced Therapy, Target: Type 2 Diabetes Honor Roll, Get With The Guidelines® Stroke Gold Plus WALNUT RIDGE Lawrence Memorial Hospital STEMI: Silver Plus Referring WYNNE CrossRidge Community Hospital STEMI: Silver Referring
MALVERN Baptist Health Medical Center-Hot Spring County STEMI: Silver Referring ARKANSAS HOSPITALS | FALL 2023 19
WORKFORCE SOLUTIONS
FOCUS ON WELLNESS By Kate Franks, UAMS Director of Clinical Communications • Photography by Bryan Clifton
T
o help combat the critical, nationwide shortage of nurses and other health care professionals, UAMS focuses on retaining and strengthening its employee base by offering staff a variety of wellness-focused activities in addition to its fitness center, counseling services, and resources provided by the institution’s health insurance provider. Chief Nursing Officer Trenda Ray, PhD, RN, NEA-BC, learned about wellness retreats for nursing staff at a conference in 2019 and applied
Zainab Copley, RN, prepares for the journaling session of a UAMS Health wellness retreat. 20 FALL 2023 | ARKANSAS HOSPITALS
for a $20,000 Chancellor’s Circle grant to fund a similar program at UAMS for three years. The inaugural class of 12 nurses attended the first retreat in October 2020, and now hundreds of nurses and other front-line care providers are equipped with tools and techniques to combat stress and burnout. “We hold the sessions off campus to help participants disconnect and focus on the retreat and themselves,” Ray says. “The classes are small, and the day includes sessions on nutrition, mindfulness and gratitude, movement, journaling, and resources available to them at UAMS. We provide lunch, and managers are encouraged to provide an opportunity for each staff member to schedule a half-day for personal well-being.” The retreats typically begin with a “Nurturing the Mind” session led by the UAMS Mindfulness Program. This is followed by a movement session featuring “Yoga for Healthcare Professionals” where participants learn poses that can help with pain and soreness. These can be performed in a chair or on a mat on the floor and are designed for all levels of fitness. Representatives from the UAMS Culinary Medicine program lead the nutrition session, inviting those at the retreat to add healthy alternatives to their diet rather than take away from their current diet. Participants get to sample healthy recipes and discuss timesaving techniques such as cooking once and eating twice. After a catered lunch, the retreat wraps up with journal activities with Natalie Cannady, M.Ed., UAMS Director of Wellness
and Chief Wellness Officer. With supplied journals and materials, the group goes through several prompts and a group conversation about what brings them happiness. During this time for reflection each participant is asked to think about what is important in their life. “Our research shows that of all health care disciplines, nurses demonstrate the highest risk of all three types of burnout – work-related, personal, and patient/client-related burnout,” Ray says. “Keep in mind, this research was conducted before the pandemic. Once (Top photo) Sherry Youngblood, RN, BSN, YT, leads a group of UAMS nurses in a “Yoga for the pandemic hit, we realized Healthcare Professionals” session during a recent wellness retreat. (Above) Alyssa Frisby, the true importance of these MS, RD, LD, offers nutrition advice and healthy cooking tips to UAMS nurses. retreats, and we remained committed to starting this program. For more of personal protective equipment and number of than a year, we limited class sizes so participants patients in our hospital to availability of vaccines could be six feet apart, and they wore masks and the number of employees not cleared to when necessary. Just having time away from come to work. Because we demonstrated that work and being able to focus on themselves we cared about our nursing staff as people rather than their patients or families was a huge rather than just employees, we created a level relief. of trust that helped us treat more than 5,000 “We are now approaching the third hospitalized patients without any deaths among anniversary of our first retreat, and I have to the thousands of health care employees who say it’s been a win-win,” she continues. “During provided direct patient care. various retreat discussions, our nurses made it “For each individual nurse, the retreat is an clear that we can help by being open and honest opportunity to step away and reflect on their life in leader communication. From the beginning of and their work. For UAMS as an institution, these the pandemic, we recognized how important it retreats have become an important part of our is to be up front about everything from supplies culture,” Ray concludes. ARKANSAS HOSPITALS | FALL 2023 21
WORKFORCE SOLUTIONS
ATTRACTING
By Kate Franks, Director of Clinical Communications, UAMS • Photography by Evan Lewis
E
arlier this year, UAMS Health opened three new facilities requiring additional radiology technologists, creating an urgent hiring challenge in an already tight labor market. “We quickly realized that we wouldn’t be able to open these facilities – on the drawing board for three or more years – if we didn’t find qualified radiology technologists to work there,” says Tammy Jones, PhD, RN, NE-BC and UAMS Health Chief Officer for the Perioperative, Interventional & Imaging Services Division. “We began an aggressive hiring campaign that included sign-on bonuses, referral bonuses, the opportunity for lodging
for those who live outside Little Rock, and a variety of locations, shifts, and care settings.” An email campaign targeted three distinct groups – former employees, current UAMS students, and radiation technologists working at other locations around Arkansas. Social media marketing was designed to reach students at other training programs across the state, and virtual and in-person job fairs were staffed with department managers and human resources personnel so candidates could interview and sign on for a new job during a single visit. “The radiation technologist shortage is reminiscent of nursing shortages, so we looked at the incentives and bonuses we use to recruit nurses,” Jones says, “but we knew we couldn’t solve this issue with money alone. “We recently rehired Jeremy Hightower, MBA, CNMT, RT(CT), as director of imaging services, and he took ownership of the email campaign, personally responding to each inquiry. His commitment to ensuring an inviting work culture in the department is playing a key role in the hiring and retention of a great team of technologists.” The concepts used in this recruitment effort have expanded across UAMS Health to help fill other openings. UAMS Chief People and Culture Officer, Michelle Wiles, explains. “We Assistant Professor John Callaway demonstrates patient placement to Radiologic Imaging recently began a ‘welcome Sciences students in the UAMS College of Health Professions. 22 FALL 2023 | ARKANSAS HOSPITALS
THE BEST back’ campaign with an e-mail inviting professionals for generations to come,” says certain employees who left UAMS Health Wiles. “To fulfill our mission to support the in the past three years to come back home. people of Arkansas, UAMS also takes a longThe communication outlines changes to our term approach to staffing challenges by offering compensation package and other benefits that programs designed to help students as young as make UAMS such a great place to work. kindergarten develop an interest in health care.” “UAMS Health is growing with several Pathways Academy and the Health Career significant new clinical practices in Central University Program, which are both part of the Arkansas, a new sports medicine facility in UAMS Division of Diversity, Equity and Northwest Arkansas, and innovative ways to Inclusion, introduce students in grades bring health care to rural parts of the state,” kindergarten through graduate programs from she says. “Whether you like small towns or across Arkansas and neighboring states to big cities, we have openings for health care opportunities in health sciences and other math professionals who are looking to advance and science-related fields. their careers. What sets UAMS apart is that as an academic medical center we are always innovating and offering opportunities for employees to learn new skills or even begin a new career. “We recently started an in-house ‘grow your own scrub tech’ program,” Jones continues. “With a commitment to stay at UAMS Health for two years after completing the program, UAMS will pay for an online [training] program and provide clinical training here at UAMS. We already have several employees participating in this program, and we’re looking forward to having them join our surgical services team.” “Our population is aging, and there will be Students in the Pre-Health Scholars Program at UAMS learn how demand for health care lifelike manikins are used in medical training. ARKANSAS HOSPITALS | FALL 2023 23
QUALITY QUALITY CARE... THAT THAT FEELS LIKE HOME.
The care. Each Eachcommunity communityisiscentered centered TheGreenhouse GreenhouseCottage Cottagemodel modelis is reinventing reinventing long-term long-term care. around quality care, care,have haveday-to-day day-to-day aroundloving lovinghomes homeswhere whereelders elders are are supported supported by quality freedom, each cottage cottageyou youwill willfind find12 12private, private, freedom,and andpositive positiverelationships relationships are are nurtured. nurtured. In each spacious This model modelallows allowsaahigher higherstaff-tostaff-tospaciousrooms, rooms,each eachwith withits itsown own private private bathroom. This elder need to tothrive. thrive.Our Ourcaregivers caregiversare are elderratio, ratio,providing providingthe thedirect directcare care and and attention they need dedicatedtotothe thepeople peoplethey theyserve, serve, helping helping to create genuine, dedicated genuine,meaningful meaningfulrelationships. relationships. Witheight eightfacilities facilitiesacross acrossthe thestate, state, we we are conveniently conveniently located With locatedto toserve serveyour yourloved lovedone one whilestill stillbeing beingclose closeto tohome. home. while
Little Rock | 501-404-0500 Little Rock | 501-404-0500
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24 FALL 2023 | ARKANSAS HOSPITALS
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CARINGFOR FORYOUR YOUR LOVED ONE, CLOSE HOME CARING LOVED ONE, CLOSE TO TO HOME . . ■ We are family focused. As a family member or friend, ■ We are family focused. As a family member or friend,
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holistic. facility is equipped to provide ■ ■WeWe areare holistic. OurOur facility is equipped to provide each elder a customized holistic each elder withwith a customized andand holistic carecare plan uniquely designed for them. Because of this, plan uniquely designed for them. Because of this, Green House Cottage model offers better thethe Green House Cottage model offers better elderelder outcomes compared to traditional nursing homes. outcomes compared to traditional nursing homes.
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Texarkana| 870-773-7515 Texarkana| 870-773-7515 ARKANSAS HOSPITALS | FALL 2023 25
LEADER PROFILE
WHAT’S YOUR
FOCUS?
By Nancy Robertson
Jefferson Regional CEO Brian Thomas
S
ince he was named CEO of Jefferson Regional in Pine Bluff nearly seven years ago, Brian Thomas’s key focus has been on the hospital’s workforce. “Of course, our patients are at the center of all we do,” he says, “but focusing on our employees’ needs – demonstrating our appreciation, making clear their value, and doing all we can to help them remain strong and healthy – in turn enables these impassioned and compassionate caregivers to provide our patients with the best of care.” Thomas believes in engaging employees at every level by keeping them in the communication loop, listening to their concerns, and sharing success stories. Jefferson Regional’s Communications Department has electronic message boards at hospital entrances, near clocking-in locations, and at other points throughout the building. These boards detail news of interest to hospital employees and visitors alike – introducing
26 FALL 2023 | ARKANSAS HOSPITALS
new physicians, noting important hospital proceedings, explaining patient visitation policies – and were especially helpful during the COVID-19 crisis. “We also provide recap materials for staff after each management team meeting,” he explains. “The recap provides details of the decisions that were made in the meeting and how they will affect our employees. The materials are then presented to employees in their team meetings across the hospital, whether to the patient care team or support staff. It’s important to us that our employees are well-informed and are all pulling in the same direction. Our employee engagement scores show that these efforts are working. Our scores are on the rise and remain well above the nation’s average, even in a time when most hospital employee engagement scores are plummeting.” Rounding out the communications strategy are various newsletters and publications created to keep employees informed.
FULL CIRCLE WITH JEFFERSON REGIONAL
No one in his immediate family had entered the health care field when Thomas chose health care administration as a career. “In my second year of college, I took a course in health information management,” he says. “It covered everything from an introduction to anatomy to medical records management and coding.” His curiosity was piqued, and after graduating he headed straight to graduate school at the University of Alabama-Birmingham, where he pursued dual master’s degrees in health care administration and business administration. He immediately moved to Pine Bluff and joined Jefferson Regional in 1998, serving as Director of Physician Practices and Operations Support. He later served for three years as CEO at Howard Memorial Hospital in Nashville, Arkansas, and for three years as COO at J.F.K. Memorial Hospital in Indio, California. Wanting to return to the South, he and his family moved back to Alabama where he served at Crestwood Medical Center in Huntsville before ultimately coming back to Jefferson Regional in 2010. With that return, where he joined the administrative staff as Senior Vice President and COO for Jefferson Regional Medical Center, he began what is now 18 years with the health care organization. In 2017, he was named CEO, at which point he named as a key focus his dedication to the hospital’s employees.
COLLABORATIONS BENEFIT RURAL HOSPITALS
“We are always looking to grow our footprint to expand services for our patients and their families,” he says. “We look at southeast Arkansas as our backyard, and as an area where we can help provide patient services in underserved areas.” He points to Jefferson Regional’s membership in the Arkansas Rural Health Partnership (ARHP) as an important link in the hospital’s chain of collaborations. “ARHP helps rural hospitals meet challenges and work together,” he says. “It helps its members look at ways we can continue to provide, and even improve, the services we offer to patients in rural Arkansas.”
Other collaborations bring creative solutions to the rural health care dilemma – how to expand services in a time when recruiting health care professionals to the rural market is extremely challenging. He says that the partnership with UAMS and its Family Practice Residency Program has, for more than 40 years, brought medical residents to south central Arkansas for training and, potentially, a place to settle down and begin practice. Other partnerships are growing Jefferson Regional’s service lines in the areas of home health, sleep study services, emergency department coverage, and radiology services.
Brian Thomas presents the WOW award to Nutrition Services Operations Supervisor, Takara Young, for outstanding service in support of others.
“We are constantly looking for ways to bring more patient services to rural Arkansas – not to expand our brand, but to expand health care access and convenience to our patient base,” Thomas says. “Each of us who serves hospitals in rural areas must look and think outside the box in ways far different than we did 10, or even five, years ago. Rural hospitals cannot do it all on their own. That’s why we work together to constantly improve the health care picture in rural areas.” ARKANSAS HOSPITALS | FALL 2023 27
PIPELINE FOR THE FUTURE
Several years ago, ARHP created materials that can be circulated in area high schools – materials that explain what specific careers in health care look like. Videos illustrate what it’s like to be a nurse, a respiratory therapist, and many other roles, including the education needed and demands of each position that the student can expect. Introducing these materials to high schools in southeast Arkansas is fueling interest in the various career choices available in health care, and it is helping to create a pipeline for future health care workers. So is Jefferson Regional’s own School of Nursing. For more than 30 years the school has
Monticello, Southeast Arkansas College, and the University of Arkansas Pine Bluff School of Nursing, believing that it’s important to provide training for these students and, hopefully, exposure to our hospital that may result in their coming to work for us, helping serve rural Arkansas.”
A CULTURE OF COMPASSION
Thomas says he is most proud to be helping build a culture of compassion with its focus on hospital employees. “It’s all about humanity and caring,” he says, “and we develop our culture of compassion at every level of our organization. Seeking our employees’ perspectives, engaging them in decision-making, hearing from them as we care for patients – everyone knows they have a part in and the purpose of improving patient care.” He cites an especially moving example: A man was called to his dying father’s side in the Jefferson Regional Emergency Department. He arrived at the hospital at 2:30 a.m., and couldn’t find the ED. A member of the housekeeping staff who was cleaning floors spotted the man and immediately identified both his confusion and his state of anxiety. The employee shut Brian Thomas received the “2023 Business Person of the down his machine, spoke briefly with Year” award from the Jefferson County Chamber & Alliance. the man, and then walked him to the Here, he is joined by Chamber members and some of the critical care area with his arm around management team at Jefferson Regional. the man’s shoulder. This non-clinical employee recognized the need for educated the nurses of today and tomorrow, a helping hand, and helped the man reach his graduating approximately 25 students with father before he passed. each successive term. Plans are to double class Later in the morning, after his father passed, sizes and graduation rates in order to add to the man called Brian Thomas to thank him for the pool of nurses available. “Our hospital, the hospital’s care and for this technician’s other hospitals, area clinics, and other health compassion. He was so moved by the tech’s care entities are all beneficiaries of these personal outreach during his moment of crisis nursing school graduations, and we anticipate that he would not wait to pass on his gratitude. that expanding the program will result in a huge This is the culture that comes from believing success as the number of available nursing in and empowering employees. It is what comes professionals increases,” Thomas says. of employees feeling valued, not merely being “Other areas, such as the pool of available told that “you matter.” It is what Brian Thomas CNAs and LPNs, are more challenging,” he sees as his main focus as the leader of Jefferson says. “We are working with local educators and Regional, and it is not only making a meaningful with all of our area schools and universities to difference to employees and their families, but try to solve this issue. We offer rotation training also to the patients of Jefferson Regional and to students at the University of Arkansas to rural health care in Arkansas. 28 FALL 2023 | ARKANSAS HOSPITALS
MORE THAN A MEDICAL SCHOOL PATIENT ADVOCATES. PHYSICIAN LEADERS. POLICY INFLUENCERS. Contact us to learn more about the three degree programs offered on our Jonesboro Campus: Doctor of Osteopathic Medicine (D.O.) Master of Science, Biomedical Sciences (B.M.S.) Master of Public Health (M.P.H.)
nyit.edu/arkansas | 870.680.8816 | ComjbAdmissions@nyit.edu ARKANSAS HOSPITALS | FALL 2023 29
Q/A with
Brian Thomas, Jefferson Regional Arkansas Hospitals Brian Thomas
What’s on your music playlist? I lean to the generation that I grew up in, so I’ve always been a fan of 80s/90s rock and even country.
AH BT
What’s the best advice you were ever given? Over my career, I’ve been blessed to have a lot of great mentors along the road – several from my time spent here at Jefferson Regional – as well as some great leaders from my hiatus while working outside of Arkansas. There are two key pieces of advice that have stuck with me: My grandfather had a woodshop where we spent most of our time building things. I would often look up at a sign that he had on the wall of his shop. It read: There is no limit to the good one can do, if he doesn’t care who gets the credit. This wisdom speaks to the style that I have tried hard to follow in life. I now have that same sign hanging in my home office. The second piece of advice: Listen a little more than you speak…I can usually learn more when I’m listening, vs. talking.
AH BT
What is your favorite movie? My favorite movie of all time is The Shawshank Redemption (I’ve probably seen part/all of it at least 75 times). I love every aspect of the movie. It’s a great story of perseverance and endurance, no matter what the circumstances. The ending is one of the greatest conclusions of all time.
AH BT
What would you be doing if you were not in health care? I’ve always had a passion for building things, from small projects to houses or buildings. I love to start with something on paper and see it become a reality. My mother always reminds me how much I loved to play with Legos – I would apparently spend hours making things. So maybe I’d be a builder/contractor in housing or maybe even commercial construction. If not that, a fishing guide seems like a good option.
AH BT
What is something that people don’t know about you? Most people would be surprised to know that I’m a closet introvert. In my present role, it’s a given to be extroverted and engaged with everyone, but it’s something that I have to lean in to do. My family and close circle of friends know me pretty well. I’m most comfortable one-on-one or with a small group. I will say that my hospital family makes it very comfortable for me to lead.
AH BT
What do you like to do in your downtime? When I’m not at work, I am always excited to spend time outdoors. I love to hunt and fish, whether it’s alone or with family and friends.
AH BT
What is the most valuable lesson the pandemic taught you? What I learned from COVID – on a personal level – is that life is precious, family is everything, and time is more valuable than I ever thought before. On the work side, I was reminded every day of how strong and dedicated our team is here at our hospital. I know that most hospitals will echo that of their own teams, but our team here at Jefferson Regional certainly rose to the occasion. When I look back on this career, the memories of how they all rose to the challenge will be something I will never forget.
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Solutions:
HEALTH CARE WORKFORCE
High Points from the 2023 American Hospital Association Health Care Workforce Scan
T
he 2023 American Hospital Association Health Care Workforce Scan is a tool designed to help today’s hospitals assess and address staggering workforce challenges including recruitment and retention, and it helps hospitals plan future workforce strategies for both the near- and long-term. Using data, studies, in-depth reports, and other information gathered from some of the nation’s leading researchers and health care authorities, the Scan is designed to help hospitals of every size clearly identify specific workforce issues (including both cause and effect). It also can help hospitals strategize practical plans for meeting workforce needs into the future.
2023 HEALTH CARE WORKFORCE SCAN
Sponsored by
THE COVID-19 EFFECT
real factors. Recruitment was difficult in many areas of the Even before the COVID-19 pandemic struck, hospitals country (including Arkansas), and as the pandemic morphed struggled with workforce recruitment and retention. For into a multi-year reality, retention strategies that were years, predicted shortages of physicians, nurses, nurse effective pre-pandemic suddenly no longer worked. practitioners, and many other health care professionals Hospitals today deal daily with the need to attract and put the potential for a retain talented professional workforce crisis on the medical and support staff. Mental Health Issues & Burnout horizon. They are also constrained Physicians But the pandemic not by severe post-pandemic Often Experience Feelings of Burnout: only amplified existing financial impacts that have workforce challenges, it not been resolved, including also created a real-time historically high worker crisis situation where turnover rates, economic threats to health care viability/stability issues Causes of Burnout: professionals’ own health, brought on by inflation and the health of their family increased costs of caring, members, rates of physical, and the need for many mental, and emotional hospitals to decrease or scale of physicians say say burnout’s been of physicians blame of administrators exhaustion, and ultimately, back service lines in order to their burnout started building for years. administrators. feel it stems from the with COVID-19. (Physicians rate their demands of being a burnout, quickly became keep their doors open. satisfaction with their physician. 145
146
employer as only 5.5/10.) © 2022 American Hospital Association
ARKANSAS HOSPITALS | FALL 2023 31 www.aha.org | Page 32 of 40
LOOKING AHEAD
CORE CHALLENGE 1: RECONNECTING TO PURPOSE
The 2023 Workforce Scan identifies factors in play today that are significantly affecting the future workforce – whether we’re looking toward next year, 10 years from now, or beyond. These factors unsurprisingly include dire worker shortages, the need to support health care workers’ mental and physical wellMental Health Issues & Burnout Physicians Nurses Often Experience Feelings of Burnout:145
Nurse Burnout
Causes of Burnout:146
of a 2021 study’s participants reported feeling burned out within the last 3 years.147 of physicians say their burnout started with COVID-19.
report exhaustion and burnout.149
of nurses feel overwhelmed.148
150
say burnout’s been building for years.
of physicians blame administrators. (Physicians rate their satisfaction with their employer as only 151 Reporting not or not at all emotionally healthy:5.5/10.)
of administrators feel it stems from the demands of being a physician.
© 2022 American Hospital Association
www.aha.org | Page 32 of 40
Gen Z and Millennial Nurses Hardest Hit by the Pandemic
of nurses younger than 35.
How can today’s health care organizations reinspire workers to find the joy, satisfaction, and purpose that drew them to health care in the first place? How can we provide work environments that consistently support meaningful work and nurture relationship-building? We know that health care workers are passionate about helping people. The pandemic refocused hospital leadership on the need to also be passionate about caring for their workforce. Communicating with employees, implementing workplace practices that strengthen employee satisfaction, encouraging and supporting worker self-care, acknowledging the Nurse-to-patient pressure and stress in today’s work workloads have tripled. environment, and demonstrating a commitment to patient-centric care are all important factors. Perhaps the most important is ensuring that employees consistently feel heard and valued.
of all nurses.
of nurses older than 55.
CORE CHALLENGE 2: PROVIDE SUPPORT, TRAINING, AND TECHNOLOGY NEEDED TO THRIVE IN MULTIPLE CARE DELIVERY ENVIRONMENTS
The variety of settings in which patient care is delivered, both inperson and virtual, continues to expand. Health care workers today need the ability to work in, and transition seamlessly between, a wide variety of care environments, from hospitals to outpatient clinics cited low staffing as cited emotional cited high workload cited COVID-19 a factor. exhaustion. demands. direct patient care. to community facilities to anywhere that patients live. Doing this successfully requires being, major demographic shifts, changing new skills and technologies, new flexibility consumer expectations, rising costs in the workforce, and innovative strategies associated with health care delivery, and for workforce management. Cross© 2022 American Hospital Association www.aha.org | Page 33 of 40 the role of technology in reshaping care functional, interdisciplinary professional delivery. development can help build confidence The Scan focuses on three core and deepen expertise while sharpening challenges that must be addressed to leadership skills. attract, retain, and support the health care Integrating technology into the workforce, both now and in the future. The workflow optimizes productivity while challenges reflect the very real dilemmas improving worker satisfaction and freeing Arkansas hospitals face today. time for direct patient care. Causes of Burnout
In a national survey, the nurses reporting burnout:152
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CORE CHALLENGE 3: RECRUIT, RETAIN, AND BUILD A ROBUST PIPELINE
KEY FINDINGS OF 2023 HEALTH CARE WORKFORCE SCAN
COVID-19 brought with it the largest decline in the U.S. nursing workforce in 40 years. Between 2019 and 2022, that workforce lost more than 100,000 people. In 2023, burnout is high among nurses and physicians, contributing to costly workforce turnover. For hospitals of all sizes, recruitment and retention are more critical – and more challenging – than ever, especially as competition WORKFORCE SHORTAGES CONTINUE for labor remains intense. Shortages of health care workers in all roles will To meet short-term staffing needs and create persist well beyond the pandemic given today’s sustainable long-term solutions, hospitals and health highly competitive labor market. systems must develop multi-pronged strategies. Find ways to collaborate to expand training and upskilling opportunities. Consider job flexibility, shift options, and additional technology support. Provide on-the-job training opportunities. Expand nursing programs or launch new ones. Health Care Worker Shortages Consider offering creative benefits that stretch WORKER TURNOVER IS MASSIVE » 23% of health care workers say they are likely to leave the field soon. employee paychecks; »think about ways all sectors Personnel shortages of all to typesprovide ranked No. 1 on the list of hospitalPeople CEOs’ top in concerns in 2021 — of the economy – health 94% of the CEOs ranked RNs as the most pressing deficit, followed the first time 2004. nontraditional employee support andsince innovative benefits, care included – are by leaving for new jobs or new therapists, primary care physicians, physician specialists and physician extenders. such as affordable housing,technicians, help with eliminating student fields or from the job market altogether. » Nearly 1,400 hospitals or 31% of hospitals reported a critical staffing shortage to the federal debt, on-site childcare, even eldercare. Innovations like government as of Jan. 19, 2022. these can help attract and retain workers. 104
105
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Care Worker Shortages
»
Of the 6.4 million workers who quit their jobs in November 2021, health care workers had the second highest rate at 6.4%, noted the Bureau of Labor Statistics.108
BUILDING AND NURTURING YOUR WORKFORCE
104 health care workers say they are likely to leave the soon.400,000 » field By 2026, skilled and semi-skilled mental health workers are predicted to leave the occupation
Existing workforce challenges, made worse by the pandemic, appear likely to continue well into the ans, therapists, primary care physicians, physician specialists and physician extenders. future. To rebuild and Ancillary nurture a thriving health care Staff Shortages ,400 hospitals or 31% of hospitals reported a critical staffing shortage to the federal workforce requires commitment and collaboration from Lower-Wage Staff Shortages WORKERS NEED SUPPORT ment as of Jan. 19, 2022. all stakeholders at the individual, organizational, and » About 9.7 million individuals currently work in lower-wage health care positions (e.g., medical Health Care Workers’ mental and physical 4 million workers who quit their jobs in November 2021, health care workers had the second the next five years rising to 10.7 community rate at 6.4%, noted the Bureaulevels. of Labor Statistics. assistants, home health aides, nursing assistants) with the need inwell-being requires tangible help and support million. Together, we canhealth address workforce supply, strengthen 400,000 skilled and semi-skilled mental workers are predicted to leave the occupation from their leadership, and respect from the » Trends project that 6.5 million employees will permanently leave their positions by 2026 with 1.9 leaving a 10% increase in demand. workforce resilience, and ensure our ability to deliver the communities they serve. million people replacing them — leaving a deficit of 4.6 million. best possible care to the communities we serve, now and » New York and California will have the largest staff shortages, each projected to fall short by 500,000 ry Staffinto Shortages the future. by 2026.
109 entirely, CEOs’ leavingtop a 10% increase in demand. el shortages of all types ranked No. 1 on the list of hospital concerns in 2021 — time since 2004. 105 94% of the CEOs ranked RNs as the most pressing deficit, followed by 106
107
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111
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ge Staff Shortages
»
“Ancillary staff such as patient care assistants can take jobs offering the same pay for less strenuous work or more flexible(e.g., hours, or work from home, or even get better pay … .”113 7 million individuals currently work in lower-wage health care positions medical
To read the full report, go to aha.org/aha-workforce-scan
ts, home health aides, nursing assistants) with the need in the next five years rising to 10.7
10
Allied Health Professional Shortages
project that 6.5 million employees will permanently leave their positions by 2026 with 1.9 114 111 it’s projected these will see the most increase for demand: 2030, people replacing them — leaving a deficit of 4.6 By million.
k and California will have the largest staff shortages, each projected to fall short by 500,000
112
Allied Health
ry staff such as patient care assistants can take jobs offering the same pay for less strenuous Professional more flexible hours, or work from home, or even get better pay … .”113
Shortages
DISRUPTION OPENS NEW OPPORTUNITIES Health care’s challenges have also created unique opportunities to accelerate change and improve the ways care is delivered.
By 2030, it’s Health Professional Shortages projected these ’s projected these most increase for demand:114 willwill seesee thethe most increase for demand:
© 2022 American Hospital Association
ARE ALL STAKEHOLDERS ON BOARD? Ensuring the health and safety of the health www.aha.org | Page 28 of 40 care workforce – and of their patients – requires commitment at the individual, organizational, and community levels. ARKANSAS HOSPITALS | FALL 2023 33
HOW TO BUILD YOUR
FUTURE WORKFORCE PIPELINE From the American Hospital Association
H
ospitals and health systems continue to face acute workforce challenges. Competition for labor remains intense, particularly for nurses. Staffing costs are skyrocketing, especially in small rural hospitals that often find it hard to attract workers. But as the American Hospital Association’s recently released 2023 Health Care Workforce
Scan points out, member organizations are finding innovative ways to recruit, retain staff, and build a robust worker pipeline for the future. The report also offers ways to reconnect clinicians to purpose and ideas about how to provide the support, training and technology clinicians need to thrive in multiple care delivery environments.
4 WAYS TO BUILD YOUR WORKFORCE PIPELINE
1 | COLLABORATE TO EXPAND TRAINING OPTIONS. Partner with schools, community organizations, and other health care organizations to create apprenticeships, earn-while-you-learn programs, and other on-the-job training opportunities. Here are some ways provider organizations are partnering to grow training programs for prospective health care workers. • Mary Washington Healthcare in Virginia began partnering with Germanna Community College on an earn-while-you-learn program, onboarding two cohorts of as many as 60 students per year. Nursing students work 12-20 hours a week using a clinical rotation model. The program now includes another nursing school as well as mentor models for nursing assistants and is considering an apprenticeship model for other clinical roles such as surgical technologists. • Participants in the Jump Start program at MercyOne in Iowa receive a monthly stipend while they finish nursing school, with MercyOne covering the cost of board exams and licensing fees. After RN licensure, the nurses begin work at MercyOne.
34 SUMMER 2023 | ARKANSAS HOSPITALS
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GET INVOLVED! Hospital employees: Gain access to
specialized training, networking, and professional development opportunities. Join your affiliate group by contacting Cassandra Van Tassel at cvantassel@ arkhospitals.org. Arkansas Association for Healthcare Engineering (AAHE) Arkansas Association for Healthcare Quality (AAHQ) Arkansas Association for Medical Staff Services (ArkAMSS) Arkansas Association of Hospital Trustees (AAHT) Arkansas Healthcare Human Resources Association (AHHRA) Arkansas Health Executives Forum (AHEF) Arkansas Hospital Auxiliary Association (AHAA) Arkansas Organization of Nurse Leaders (ArONL) Arkansas Society for Directors of Volunteer Services (ASDVS) Arkansas Social Workers in Health Care (ASWHC) Arkansas Society for Healthcare Marketing & Public Relations (ASHM&PR) Healthcare Financial Management Association (HFMA) Society for Arkansas Healthcare Purchasing and Materials Management (SAHPMM)
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• Project Firstline is the Centers for Disease Control and Prevention’s national training collaborative for health care infection prevention and control. As part of the program, the AHA is partnering with the League for Innovation in the Community College to provide comprehensive infection control education and practice for nursing students and allied health students. 2 | RECRUIT INTERNATIONALLY. Over the next three years, Sanford Health in Sioux Falls, South Dakota, plans to hire more than 700 internationally trained nurses for its health system. Sanford covers housing during the initial transition period and has instituted a program to help the nurses get acculturated to their new communities. 3 | BE FLEXIBLE. Build flexibility into jobs wherever possible, and provide technological support that enables remote work, including for roles traditionally handled in person. Modernize staffing models and offer more shift options with variable start times, durations, locations, and sharing opportunities. Integrate app-enabled capabilities to support selfscheduling, work-from-home opportunities, and schedule flexibility. • Pittsburgh-based Allegheny Health Network’s (AHN) mobile internal staffing model offers nurses and technicians in select roles the opportunity to rotate to AHN hospitals throughout the state. AHN also has options for employees who prefer to work weekends or night shifts. • Yale New Haven Hospital (YNHH) developed an alternative staffing model that uses a variety of licensed and nonlicensed nursing team members to support critical care registered nurses. YNHH leaders also created flex shifts, including four-hour support role shifts, for nurses whose schedules could not accommodate a traditional-length shift.
36 FALL 2023 | ARKANSAS HOSPITALS
4 | BOOST INVESTMENT IN UPSKILLING. More than half of health care workers say they are interested in improving their skills, or upskilling. Education and upskilling programs can reduce financial barriers to choosing a health care career and advancing professionally. • UC Health in Colorado plans to invest $50 million in its new Ascend leadership program to help current and prospective employees earn clinical certification, participate in foundational learning programs such as English language and college prep, and earn degrees in areas like social work and behavioral health.
5 THINGS TO THINK ABOUT GOING FORWARD
1. What opportunities can you provide to increase shadow experiences for clinical positions? 2. What local universities, community colleges, and/or online educational platforms can you partner with to attract high school students to health care careers? 3. What new career pathways can you create by expanding upskilling and professional development training? 4. In what ways can you increase scheduling flexibility to better meet workers’ lifebalance objectives? 5. How can you prepare to ensure highquality patient care in the face of continuing labor shortages?
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AHA SERVICES PRESENTS
MAXIMIZING YOUR FLEXIBLE RESOURCES WITH SHIFTS TECHNOLOGY H
ealth care staffing as a growing challenge, both pre- and post-pandemic, affects organizations across the country. Staffing shortages, scheduling conflicts, and unexpected call-offs result in serious disruptions in patient care. Recent data reveal that clinician burnout alone is costing a staggering $4.6 billion annually, with roughly 47% of U.S. health care workers planning to leave their profession by 2025 if this trend continues. While there are no quick fixes in an industry as complex as health care, alternative workforce solutions utilizing technology can be harnessed to solve some of the field’s biggest challenges. One emerging workforce solution is to engage gig workers who wish to earn extra income by providing on-demand services. Long before Uber or Upwork, the health care industry was one of the earliest adopters of the gig economy, as exemplified with per diem and registry nurses in float pools. While traditional float pool models were not tech-enabled and typically required higher FTE commitment than modern-day gig employment, today’s workers have different expectations and preferences. Health care organizations should explore a new way of working and engaging workers by providing flexibility and control through app-based technology.
UTILIZING THE SHIFTS APP
In this post, we’ll delve into how the Shifts app, part of Qualivis’s Lotus Connect Suite, helps health care organizations mobilize all talent – float pool, core staff, PRN gig workers and local agencies – making scheduling and filling open shifts more manageable and efficient.
ACCESSIBILITY
Through the Shifts platform, you can broadcast open shift needs to your internal workforce and a local pool of highly qualified health care professionals (including nurses, allied health professionals and support staff) at a moment’s
Qualivis ensures open shifts get pushed out via the Shifts app in a tiered fashion to meet your hospital’s clinical, financial, and operational goals. The Shifts app is part of the Lotus Connect Suite.
ARKANSAS HOSPITALS | FALL 2023 37
notice. The platform is easy to use, allowing managers and schedulers to book clinicians who are available and meet their requirements. With realtime updates and in-app communications, Shifts makes filling positions easy and efficient.
COMPLIANCE MANAGEMENT
Shifts offers a streamlined document repository that allows easy access to a health care professional’s entire set of credentials and compliant paperwork. Qualivis provides dedicated compliance liaisons ready to take the lead in proactively handling document management. We collaborate closely with clinicians, ensuring that any missing, incomplete, or soon-to-expire documents are promptly obtained. This meticulous approach guarantees that you can confidently deploy clinicians without worrying about expired credentials.
COST SAVINGS
The Shifts app offers a significant reduction in premium labor costs. By leveraging technology to streamline the open shift management and scheduling process, Shifts enables health care facilities to maximize the usage of their internal staff. Through an automated tiering process, configurable by the facility, Shifts analyzes the
shift costs and incentive pricing to recommend the most cost-effective resource. Sometimes with overtime costs and shift incentives, scheduling a local gig worker provides a cost savings opportunity for the health care facility. As an AIenabled platform, Shifts forecasts gaps in patient demand and staffing levels making it easier than ever for employers to optimize staffing levels and costs – giving you a 360-degree view of your flexible workforce. As health care systems look to bolster their talent pools and reduce premium labor costs, becoming a flexible employer is important. But it’s not easy. Technology engages with health care gig workers in a marketplace that makes scheduling and filling open shifts more manageable and more efficient. However, it takes a combination of technology, strategies, and best practices to overcome health care’s workforce challenges. Whether you are building your resource pool from scratch or revamping your current pool with gig workers, Qualivis can help you maximize outcomes and become the flexible employer of the future. For more information about Shifts, part of the Lotus Connect suite, contact Natalie Phillips at nphillips@ qualivis.com.
Once clinicians are credentialed and have been onboarded at your facility, they can set their availability, browse open shifts at facilities, and swipe right to accept an open shift.
Qualivis is an endorsed vendor of AHA Services, Inc., and is the only vendor-accountable managed service provider created by hospitals for hospitals. Partnering with more than 200 vetted agencies, Qualivis offers workforce solutions to optimize health care staffing and build a stronger, more sustainable workforce.
38 FALL 2023 | ARKANSAS HOSPITALS
Baptist Health Medical Center–Heber Springs
CMS Announces 2023 Five-Star Overall Hospital Ratings AHA
member hospitals Baptist H e a l t h M e d i c a l C e n t e rHeber Springs and Veterans Health Care System of the Ozarks have been granted outstanding five-star overall hospital ratings by the Centers for Medicaid and Medicare Services (CMS). The Overall Hospital Quality Star Rating summarizes a variety of measures across five areas of quality. Only 483, or 10.4%, of hospitals in the U.S. achieved the five-star overall rating for 2023. The third Arkansas hospital achieving this rating is Arkansas Heart Hospital, which is not a member of the Arkansas Hospital Association. The announcement was made July 26. CMS assigns star ratings to U.S. hospitals each year based on 46 hospital quality measures divided into five quality categories: safety of care, mortality, patient experience, readmission rates, and timely and effective care.
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40 FALL 2023 | ARKANSAS HOSPITALS
COACH'S PLAYBOOK
Solutions for Performance Improvement:
A PEACEFUL PATH TO
EXCELLENCE By Kay Kendall
T
he Arkansas Institute for Performance Use of a Baldrige-based self-assessment tool Excellence, home of the Governor’s Quality followed by participation in a tiered Quality Award Program, is one of the most successful Program in the Baldrige Alliance provides Baldrige-based programs in the Baldrige Alliance. evidence of a proactive approach and continuous The Arkansas program is known for producing a improvement mindset. high number of applications each award cycle, ranking first place in 2020. A SIMPLIFIED STARTING POINT Like many other Alliance programs, it offers With the many challenges hospitals currently face, several tiers of quality improvement and even the earliest waypoint on your organization’s performance excellence work (including award performance-improvement journey may seem recognition), and the varying program trainings daunting. and applications processes seek to make it There is a new, free product recently easier for organizations released by the to “jump into the pool” by Baldrige Program for degree. Whether starting Performance Excellence at the Challenge level that could simplify your or at incremental levels organization’s leap to the right up to the highest first tier of the Arkansas level of recognition, the Institute for Performance Governor’s Quality Award Excellence program. Program offers many Here’s how the new opportunities for health program is described by care organizations (and Baldrige: “Foundations others) to measure their for a Successful BusiFoundations progress in the journey of ness describes organizafor a Successful Business performance excellence. tional success in seven Based on the Baldrige Excellence Framework® Use of the Baldrigefundamental areas that based program can help apply to any corporation, answer current federal nonprofit, government, requirements for proactive or academic institution. It process improvement. provides a ‘golden thread’ The CMS Revision that ties various parts toto State Operations Manual (SOM), Hospital gether into a coordinated system. The content Appendix A – Interpretive Guidelines for 42 in this overview can also be found in a series of CFR 482-21, Quality Assessment & Performance interactive modules.”1 Improvement (QAPI) Program was issued Each interactive module is accompanied by March 9, 2023. The emphasis on Conditions of a set of slides defining the key elements of that Participation (CoP) is the promotion of proactive module along with a series of questions that help process improvements as part of a hospital’s your team think about your own organization and QAPI program. what is most important to its practice. https://www.nist.gov/baldrige/foundations-successful-business
ARKANSAS HOSPITALS | FALL 2023 41
As an example, here’s how the Leadership module begins: Leadership 1. How do your leaders model your organization’s values? 2. How do your leaders communicate with employees and customers? 3. How do you listen to employees and customers? 4. In what ways do your leaders ensure that the organization obeys the law? 5. How does your leadership fulfill its responsibilities to the neighboring community and public at large? Following the group of eight foundational modules you’ll find an interactive module designed to help your organization focus on where improvement is most needed. Additional materials then help your improvement team determine next steps and develop related action plans.
STEPPING INTO THE EXCELLENCE PROCESS
Once your team completes this simplified approach to the Baldrige Excellence Framework,
you can re-examine the various levels of the Arkansas’ Governors’ Quality Award Program and determine at which level you’d like to participate. Depending upon your organization’s maturity, your team may want to start at one of the lower levels requiring a shorter application, or you may discover that you’re ready to apply for the Achievement Recognition (Level 3) or the Governor’s Award Recognition (Level 4). The Foundations program will help determine where your organization already stands in the process.
GIVE THIS SOLUTION A TRY
Many leaders are reluctant to take what feels like a big step by developing and submitting an award application, but this new product from the Baldrige Performance Excellence Program can provide a peaceful pathway to beginning your performance excellence journey. If you have any questions along the way, please feel free to contact the helpful folks at the Arkansas Governors’ Quality Award. https:// www.arkansas-quality.org/ References: 1 https://www.nist.gov/baldrige/self-assessing/ improvement-tools/foundations-successful-business
ARKANSAS GOVERNOR’S QUALITY AWARD:
THE BASICS
T
he Governor’s Quality Award (GQA) is administered by the Arkansas Institute for Performance Excellence, a 501(C)3 organization. The program was developed to help organizations improve their processes and, ultimately, performance. The team uses the Malcolm Baldrige National Quality Award as a basis for the Arkansas process.
The Institute is one of 30 members of the national Alliance for Performance Excellence. There are four levels of achievement within the Arkansas program: Challenge, Commitment, Achievement, and Governor’s Award. Organizations that earn the Governor’s Award may go on to apply for the Malcolm Baldrige National Quality Award.
Coaching and training in how to most accurately present your organization through the application process are a part of the program. Examiners provide detailed feedback reports following the application process. More information on the program is available at www.arkansas-quality. org or by contacting Trish Villines at tvillines@arkansasstatechamber.com.
The team at BaldrigeCoach would be glad to help guide your hospital’s quest for process improvement. As CEO and Principal of BaldrigeCoach, Kay Kendall coaches organizations on their paths to performance excellence using the Malcolm Baldrige National Quality Award Criteria as a framework. Her team, working with health care and other organizations, has mentored 24 National Quality Award recipients. In each edition of Arkansas Hospitals, Kay offers readers quality improvement tips from her coaching playbook. Contact Kay at 972.489.3611 or Kay@Baldrige-Coach.com. 42 FALL 2023 | ARKANSAS HOSPITALS
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AUGMENTING PATIENT CARE:
REMOTE PATIENT MONITORING By Amy Rogers
D
uring the COVID-19 pandemic, health care systems across the U.S. were overburdened with staff and resource shortages while managing substantial surges in case numbers. They faced heightened anxiety around an uncertain future. Despite burnout and immense stress, health care professionals continued to push through the social, mental, and emotional challenges they faced. The pandemic exposed a clear need for unprecedented services to relieve the building pressure on the workforce while expanding access to care.
AFMC’S PANDEMIC RELIEF SERVICES
AFMC provided pandemic relief services for various state and local entities during the COVID crisis. Our experienced nursing staff comprised a large 44 FALL 2023 | ARKANSAS HOSPITALS
portion of AFMC’s pandemic support team, making a quick pivot possible so we could aid Arkansas’s extensive health care system by offering remote patient monitoring. Through a collaborative effort, AFMC implemented a six-week pilot program to provide remote patient monitoring services, giving respite to overworked and overwhelmed staff. In its most basic form, remote patient monitoring involves using electronic tools to record biometric data, such as heart rate, blood pressure, and oxygen levels. At the same time, a nurse or provider in a separate location reviews the data, often in real- or near-real time. In the pilot program, six to eight AFMC nurses were on call throughout the day, rotating 12-hour shifts to ensure support was always available. Hospital staff identified patients progressing to a more stable condition and sent each one home
with a remote monitoring device that sent signals to a cell phone, allowing continuous monitoring by clinical staff. AFMC trained nurses, established clinical protocols, developed scripts, identified evaluation metrics, and staffed the initiative 24 hours a day, seven days a week. Monitored patients were given immediate phone access to a nurse for questions or to discuss undocumented health concerns. Instead of dialing 911 for emergency services, a patient could reach an on-call nurse who, after a brief discussion and assessment, would address the concern over the phone or facilitate an emergency referral if the patient’s condition was critical.
REMOTE MONITORING’S ADVANTAGES
Sending patients home with a monitoring device and providing ongoing monitoring by experienced nurses reduces hospital stays, relieving the burden on hospital staff and opening hospital beds for more critical patients. A shorter hospital stay also reduces the overall cost of patient care. A patient who recovers at home is less exposed to other diseases and poses a smaller health risk to others, as well. Once the patient is at home with a remote monitoring device, clinicians review the patient’s data, craft a treatment plan, and refer to emergency services when needed, greatly reducing the time for inpatient critical care.
AN UNEXPECTED BENEFIT
ADVANTAGES FOR RURAL PATIENTS
For patients in rural areas, remote patient monitoring also provided a new avenue to care. Instead of traveling several miles for an appointment, a patient could virtually consult with a health care professional to ensure they were taking the necessary precautions and proactive steps to recovery. When on-call nurses had to refer patients in critical condition to the emergency room, they could share patient vitals tracked via the remote patient monitoring devices with the emergency department staff. In time-sensitive medical emergencies, having a pre-tracked log of the patient’s vitals saves a step and allows quicker treatment time. During the unpredictable circumstances of the pandemic, near-instant access to patient data proved to be a game-changer for those in isolation.
A CRUCIAL LIFELINE
On a more localized scale, AFMC’s work in providing remote patient monitoring services was a crucial lifeline for patients and staff facing daunting challenges during a period of profound unease and unpredictability. Remote patient monitoring facilitated swift action if patients’ conditions worsened. Quicker
A shorter hospital stay also reduces the overall cost of patient care.
One unexpected benefit of remote patient monitoring during the pandemic was its role as a vehicle for long-lasting education and relief for patients, particularly those with chronic conditions. While consulting with patients by phone, opportunities arose for the on-call nurses to educate their patients about their symptoms and ease their apprehensions. Time taken to teach patients more about managing their conditions helped alleviate fears and concerns, reduce anxiety, and empower patients to take the right steps to improve their health outcomes. Offering patients an opportunity to consult with a health care professional also fosters a connection between the patient and the doctor or nurse, an essential component of retention and continuing care.
responses prevented complications and ultimately saved lives. As traditional health care systems faced overwhelming strains and limited resources, remote patient monitoring reduced the need for in-person checks, allowing medical professionals to reallocate their time and energy, focusing on critical cases while safeguarding their own health. This new approach to recovery underscored the importance of adaptability in times of crisis and the remarkable advancements that can be made in the face of adversity.
Amy Rogers, BSN, RN, serves as Director, Clinical Services at the Arkansas Foundation for Medical Care (AFMC).
ARKANSAS HOSPITALS | FALL 2023 45
2023 Legislative Summary By Jodiane Tritt, Executive Vice President, Arkansas Hospital Association
T
he 94th General Assembly left Arkansas with 890 new Acts, most of which became effective August 1, 2023. Acts with emergency clauses – those enacted by a super majority of legislators who approve the act because its effect is necessary for the immediate preservation of public peace, health, and safety – took effect on the dates approved in each of those Acts. Governor Sarah Huckabee Sanders, our first female Governor and the youngest Governor in the nation this year, made it clear that education reform was her first priority for the session. Our legislature followed her lead and created the LEARNS Act, which will be the hallmark of this General Assembly’s work. Major changes to the health care system were understandably not center stage this session. There are plenty of health care highlights, nonetheless.
Legislators did make some strides in ensuring that Medicaid covers behavioral health screenings. There are a couple of Acts that will add Medicaid coverage for depression screenings for birth mothers (Act 316 covers a screen within six weeks post-delivery; Act 462 covers a screen during pregnancy). Act 494
requires Medicaid and commercial payor coverage for behavioral health screenings and services in hospital outpatient settings. Act 513 adds supplemental reimbursement for physicians participating in the Patient Center Medical Home program for preventive and behavioral health services.
MEDICAID
Since 2013, the highest legislative priority has been the appropriation for the Department of Human Services Division of Medical Services. This requires a ¾ vote of approval in each chamber. This session, Act 865, which achieves this appropriation, passed with little fanfare. There were no tweaks to the ARHOME Medicaid Expansion program nor were there major changes in Medicaid reimbursement methodology. 46 FALL 2023 | ARKANSAS HOSPITALS
2¢ Dept. of Public Safety
41.8¢ Public School Fund & Dept. of Education
9.2¢ Dept. of Corrections
Excludes “Off The Top“ deductions and payments such as income tax refunds, claims, debt services, etc.
WORKFORCE
over time. Three in succession are Act 672, which creates nursing earn-to-learn programs intended to minimize duplicative clinical hours; Act 673, which allows the nursing board to collect, report, track, and trend data for nursing education and work settings; and Act 674, which creates a Clinical Nurse Education
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As the pandemic-related Public Health Emergency winds down, hospitals are still experiencing dramatic workforce challenges. While new funding was not authorized, there were a number of Acts that are intended to lay the groundwork to decrease the nursing shortage
12.6¢ Institutions of Higher Education
30.9¢ DHS & Dept. of Health
3.5¢ General Gov’t & Local Aid
Portal at the Arkansas Department of Health to streamline student clinical placements into health care settings. Pursuant to Act 313, the Arkansas Nurses Association is mandated to provide the Arkansas Department of Health a digital poster that health care facilities must post reminding the public that attacking a health care worker is a felony. These signs/ posters are required to be displayed at entrances, in patient waiting areas, emergency departments, clinics, and long-term care facilities. That same Act also allows a health care worker who is assaulted to use the address of the assault in the police report instead of the health care worker’s home. While many bills were targeted toward the nursing shortage, Act 303 addresses Physician Assistants. Today, PAs in Arkansas are authorized to be identified as a treating provider for insurance and billing claims. The Graduate Residency Expansion Board membership has been amended via Acts 663 and 844, and rules will be established to allocate set-aside funding to approved programs.
PAYOR ISSUES
Working with an enormous group of stakeholders – both health care provider groups and insurance companies and advocates – Senator Missy Irvin and Representative Lee Johnson created Act 575, Arkansas’s version of a prior authorization “Gold Card” for health care providers. Beginning in January 2024, health care providers who received approval for 90% or more of the health care provider’s prior authorization ARKANSAS HOSPITALS | FALL 2023 47
requests based on a review of the provider’s utilization of health care services from January 1, 2022, through June 2022, shall be exempt from obtaining a prior authorization for certain insurance plans. The PASSEs and marketplace plans have an extra year to setup their Gold Card processes, which are set by statute to begin January 1, 2025. The Act builds upon the existing Prior Authorization Transparency Act and defines timelines and procedures for appeals of denied Gold Cards. It further recognizes that, potentially, there are certain drugs, medicines, biological products, pharmaceuticals, or pharmaceutical services that could require a prior authorization, even if the health care provider prescribing it is approved more than 90% of the time. Beginning January 1, 2024, a health care insurer or pharmacy benefits manager shall submit a written request to the Arkansas State Board of Pharmacy to be reviewed for continuation of a prior authorization by a specified health benefit plan. The Act allows the State Board of Pharmacy and the Arkansas State Medical Board to establish criteria and procedures to review requests of health benefit plans in these circumstances. In addition to the Gold Card legislation, there are a couple of other Acts that impact prior authorizations. Act 87 clarifies that out-ofstate health care insurers are subject to the Prior Authorization Transparency Act and Act 501 clarifies the appeal process for and the timeliness related to an appeal for a denial of an urgent health care service. Unrelated to prior authorizations, Act 576 prohibits a health insurer from leasing a health care contract or provider network
Act 54 reduces community paramedic training hours to 160 hours, which may increase the number of community paramedics in Arkansas communities.
48 FALL 2023 | ARKANSAS HOSPITALS
and regulates the lease, rental, or sale of a health care contract to a provider network or a third-party administrator.
RURAL EMERGENCY HOSPITALS
The federal Consolidated Appropriations Act of 2021 created a new hospital licensure – the Rural Emergency Hospital – that allows a critical access hospital or a rural hospital with fewer than 50 beds to give up inpatient beds for a $272,866 monthly stipend and a 5% enhanced Medicare outpatient rate. In order for Arkansas to take advantage of this voluntary conversion, Act 59 was created so that the Arkansas Department of Health can create the state licensure status. The first Arkansas REH – St. Bernards Five Rivers Medical Center in Pocohontas – was set to begin its new designation on September 1, 2023.
PHARMACY
Other than four permits grandfathered-in from a 1975 law, Arkansas’s not-for-profit, tax exempt, and governmental hospitals are disallowed from obtaining a retail pharmacy permit. Any for-profit hospital may own pharmacy permits on or off hospital campuses. Recognizing a full repeal would be vehemently opposed by the pharmacy industry, HB 1311 was filed in an attempt to allow one on-campus retail pharmacy permit for a non-profit, tax exempt, or governmentally funded hospital with fewer than 1,000 employees and up to three oncampus permits for those hospitals with 1,000 employees or more. Unfortunately, HB 1311 was an unsuccessful attempt at amending the prohibition. Hospitals remain concerned about our patients’ access to prescriptions. With two pharmacists serving in the General Assembly and leading the way, Act 233 was passed to create a hospital continuity of care endorsement. As of August 1, 2023, a hospital wishing to enter into a Memorandum of Understanding with the Arkansas Pharmacy Board may be granted the authority to dispense up to a 30-day supply of outpatient drugs
to patients discharged from the emergency department of an inpatient setting.
EMERGENCY MEDICAL SERVICES
Arkansas hospitals understand the vital role that emergency medical services have on pre-hospital care. During this session, the EMS community made great strides to improve reimbursement for ground ambulance services (Act 597); to regulate contracts for prior authorizations for ground ambulance services (Act 578); and to allow licensed voluntary emergency medical responders to be reimbursed by Medicaid and commercial insurance (Act 258). Added to that, Act 54 reduces community paramedic training hours to 160 hours, which may increase the number of community paramedics in Arkansas communities. Likely the biggest change in emergency medical services in Arkansas is the passage of Act 480. The role of treating and transporting patients to health care facilities is well-established. Act 480 also allows emergency medical services professionals to use their skills and expertise – with a telemedicine consult – to triage and treat a patient without transport, and to be reimbursed for that care.
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WRAP UP
While the highlights are discussed in this article, each Act’s quick description (published by the Arkansas Bureau of Legislative Research) can be found at arkleg.state.ar.us.
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By the Numbers Health Care Job Growth Health-care-related occupations were 18 of the top 30 projected to be the fastest-growing for 2020-2030. Following are the top 5:
from 2020 to 2030 — much faster than the average for all occupations — adding 2.6 million jobs.
Nurse practitioners
Physical therapist assistants Home health and personal care aides
in the last year to a record 325,000-plus after many state executive orders during the pandemic granted them larger roles. Nationwide, more effective use of NPs and physician assistants could have the same impact as adding 44,000 new primary care physicians.
Medical and health services managers
Physician assistants
between 2020 and 2025 compared with 8% for health care overall. Courtesy American Hospital Association's 2023 Health Care Workforce Scan
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