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Rural hospital masters what many large hospitals have not

In 2002, Meeker Memorial Hospital in Litchfield, Minn. – population 6,500 – was at risk of joining the growing number of rural hospitals in the U.S. unable to maintain positive profit margins. Eighty-one rural hospitals closed between 2010 and August 2017, according to University of North Carolina’s Cecil G. Sheps Center for Health Services Research, and many others are vulnerable. About 41 percent of rural facilities operated with negative margins in 2016, a Chartis Group and iVantage study of 2,100 hospitals revealed. Hospital closures in small towns like Litchfield mean patients lose access to their closest emergency room, and local economies suffer devastating blows.

A single phone call may have changed Litchfield’s fate. A hospital board member called Mark Madden, an old friend who had grown up in the small community. He knew Madden had become a search consultant, helping health care organizations find qualified executives to fill vacant leadership roles. Madden, whose 86-year-old mother still lives in Litchfield, happily accepted the challenge.

Battling the currents of health care change

Meeker Memorial was a century-old pillar of the community Madden loved, but for nearly a decade the facility had weathered shrinking health care margins. As a result, certain structures, equipment, and technology required modernization, and the small facility was unable to accommodate additional patient volume. These factors, among others, hampered both patient and physician attraction.

Madden’s first priority was to meet with the hospital’s board members, physicians, and direct reports to understand what it would take to turn things around.

“Mark had a way of getting to the heart of things and really helped us hone in on the precise competencies and profile we needed in our next CEO,” says former Meeker Memorial Board Member Mike Huberty, who worked with Madden on subsequent searches.

A pivotal moment in Meeker Memorial’s journey

It was time for Meeker Memorial to make some big changes. The hospital was on the verge of losing money, the board had developed a strained relationship with the exiting CEO, and relationships with local providers were poor. Madden set out to find qualified leadership candidates and educate the board on how they would need to change their working relationship with the incumbent, if he or she were to be successful.

The priority was to identify health care leaders with the following attributes:
  • A firm grasp on the future of health care and a vision for how Meeker Memorial could develop a strategy to provide the community with high-quality, sustainable care.
  • The ability to collaborate with board members, government and community leaders, physicians, and the greater medical community on a common vision.
  • Strong financial and operational experience to ensure financial viability.
In May 2002, Mike Schramm was hired as CEO. He had turned around a smaller hospital and clinic system in Sibley County, Minn., about 50 miles from Litchfield. Meeker Memorial was a larger hospital with a strong medical staff, which appealed to Schramm.

“Mark has very good political instincts, he had a good read on the operational challenges, and his insights prepared me well for the role,” Schramm says of his experience working with Madden. “I knew exactly what I was getting into, which is a tremendous benefit when you’re entering a new organization.”

The right leader for the job

Schramm proved to be the right leader to get Meeker Memorial back on track. During his seven-year tenure as CEO, the team not only returned Meeker Memorial to profitability but also expanded it. Together with the board and medical staff, Schramm developed and embarked on a strategic plan that included:
  • Becoming certified as a critical access hospital, which provided avenues to attain additional government funding.
  • Creating a hospital foundation that helped raise capital to fund significant upgrades and a 75,000 square foot expansion, offering state-of-the-art surgical suites, as well as imaging, labor and delivery, oncology and rehabilitation services.
  • Partnering with local clinics to recruit new physicians and specialists, thereby expanding services and increasing patient volume.
“The job of running a small, community hospital is unique in that you really have to wear a lot of different hats and get deeply involved, not just in your own operations but also in those of the medical community,” Schramm says.

Passing the torch: A legacy continued

When it was time for Schramm to move on, the Meeker Memorial Board called upon Madden once again to help fill the role.

“We have confidence and faith in Mark Madden’s process because we’ve seen it work,” says Meeker Memorial Chief Quality Officer and long-time executive Ann Lien. “He meets with the right people to understand where we are today and what kind of candidate we need – which has been different each time – and then he delivers.”

With the fundamentals in place, the board’s goal was to find an individual who could further expand and develop services. Kyle Rasmussen began as CEO in late 2009 and continued the legacy of success. He recruited new physicians from Minnesota and Wisconsin to meet the community’s rising demand for services, including senior behavioral health, occupational therapy, orthopedic services, and oncology.

Rasmussen is also credited with elevating the patient experience at Meeker Memorial by further leveraging the staff’s already strong commitment to patient care. He engaged hospital employees, from maintenance to leadership, to help define a great guest experience, which is different for each patient or family member. With the introduction of the GEM (guest experience maximization) management philosophy, staff members, providers, and volunteers were empowered to do the right thing at the right time for every guest.

“Kyle’s focus on the guest experience helped every employee, no matter what their role, understand how they could positively impact patients and their families at every point of interaction with the hospital, and it was powerful,” Lien says.

Modern-day Meeker Memorial Hospital

Bustling with local volunteers and featuring modern facilities and equipment and welcoming open spaces, the Meeker Memorial experience of today is a far cry from that of 2002. Most notable are the people of Meeker Memorial, for whom the GEM philosophy has become a way of life.

For example, if a radiology appointment extends into lunch hours and a guest needs to return to work, they’ll receive a meal hand-delivered by a volunteer or staff member. If a loved one is transferred to a specialty facility in the Twin Cities, a staff member will be sure the family has a map, directions, and the means to get there. A senior patient who lives at home alone will have bus transportation arranged and regular phone follow-up on dietary and medication concerns.

As a result, Meeker Memorial has received a five-star rating from the Centers for Medicare and Medicaid Services and was recognized by the Minnesota Hospital Association for superior performance in patient safety in 2016. But the impact is most felt by Litchfield community members; the care Darlene Wendroth’s 74-year old husband receives today would not have been possible years ago. Robert Wendroth is a disabled diabetic who receives regular physician attention, physical therapy, and nutrition planning through Meeker Memorial.

And Darlene is not only a caregiver, patient, and volunteer, she is also a member of the GEM Council, comprised of several community members and representatives from each hospital department. Their charter is to discuss good and bad cases to keep improving the patient experience and enhancing the hospital’s advocacy for the community.

Although Meeker Memorial leverages the conveniences of modern technology -- such as online patient portals and telemedicine --Wendroth sees the personal attention patients receive as the hospital’s greatest asset.

“At Meeker Memorial, you are a person, not a number,” she says. “I’ve been to world-renowned medical institutions where patients are called by birth date. At Meeker Memorial, patients are called by name, and they care about what’s in the best interest of everyone they encounter.”

What’s next for the rural hospital that could?

Meeker Memorial today is a financially thriving hospital in the vibrant town of Litchfield where it is a significant employer. Rasmussen decided to retire as CEO in 2018, and Madden has been tapped once again to identify a stellar leader for the job.

Out of 54 initial prospects, the board selected Kurt Waldbillig, an experienced hospital CEO with previous success leading rural critical access facilities. This is the second leadership position Waldbillig has landed working with Madden.

“When a hospital CEO resigns it triggers a level of internal anxiety about filling the void right away, especially in a rural community,” Waldbillig explains. “Mark understands this tendency and does a great job of walking the board and leadership team through the vetting process, making sure they choose the right person not just for the hospital but also for the community.”

One of Waldbillig’s first priorities was to meet with community leaders, including the mayor, the school superintendent, county commissioners, and large private employers.

“My message is: As part of a small town, we are all connected. The community’s housing, school systems, and amenities impact the hospital’s ability to recruit providers, and a thriving hospital impacts local employment and well-being,” he says.

Mastering what many large health systems have not

In an era where hospitals of all sizes are struggling to keep up with regulatory changes and shrinking reimbursements while providing high-quality care, – all while delivering quality outcomes and high patient satisfaction – this small-town, county hospital of in Litchfield has, at least in part, figured it out.

According to Schramm, the hospital’s former CEO, the key is teamwork. “A CEO is a quarterback, but leading a county-owned hospital to succeed is a team effort,” he says. He credits the board members, medical staff, and community members with being willing to step up and help Meeker Memorial achieve its goals.

“It’s challenging for a small hospital with limited resources to keep up with all of the changing regulations and reimbursements,” Waldbillig adds. “But it is also extremely rewarding, because we get to take care of our neighbors, loved ones, and friends, and there is no one better equipped to do that than your own community members.”

Leading Meeker Memorial into the next generation of health care delivery means Waldbillig will evaluate potential relationships with many interested health care organizations. What remains constant, according to Lien, is “decisions at Meeker Memorial have and always will be guided by what allows us to best serve the members of our community.”

A hometown offers lifelong lesson

For Madden, now a 30-year veteran of the executive search profession, the Meeker Memorial experience has had a profound impact on him professionally and personally. “I got to witness the tremendous impact the job I do – placing the right leader at the right facility at the right time – can have on an entire community, and that has continued to inspire me in my career until this day,” He says.

Madden and his wife Kim, also a Litchfield native, visit their hometown several times a year, calling it a “favorite destination” of their five grandchildren. A staple of the community, Great Grandma Madden volunteered at the hospital until a year ago and still attends its Bone Builder class twice a week.

NRHA commissioned the above piece from Cejka Executive Search, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog

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