By Mary Alice Murphy

Gila Regional Medical Center Chief Executive Officer Brian Cunningham welcomed community members and hospital caregivers to the State of the Hospital address on Wednesday, Dec. 9, at the Western New Mexico University Bess-Forward Global Resource Center.

"We will look at our latest data and outcomes," Cunningham said. "The state of the hospital is in this room, working at the hospital, and taking time off. It's the caregivers who work there.

"Who are you referring to when you start a sentence with 'Gila Regional?'" he continued. "The hospital is made up of incredible people. When the Ebola outbreak hit the hospital in Dallas, the same scenario played out in every hospital in the country. There was a lot of fear around, but like every other hospital, we make sure our priorities are in place. We had to have a team in place in case someone arrived with Ebola symptoms.

"I told Gila Regional employees that we needed volunteers," Cunningham said. "We need nurses to give care and support people to take care of contaminated materials. And they stepped forward. So many nurses said; 'I want to be there to serve.' 'I want to risk my life for my community.'

"I'm so inspired and in awe of those at Gila Regional," he said. "Thank you to our caregivers.

"We have so many great things in our history," Cunningham continued "We have so many great things in past years. We have so much yet to do. We want to earn the right to call Gila Regional the best rural hospital in the country."

He said it takes engaged caregivers plus operational excellence plus strategic future plans to meet the hospital's mission, vision and values.

"We spend a lot of time discussing our culture now and forever," Cunningham said. "How can we do things as efficiently and effectively as possible, so you get the best service this time and every time?"

He said a team meets every week working on the steps to lead the hospital to its best. The directors report every month on their projects and the status of their departments.

"Our plans have plans," Cunningham said. "If we're not planning to move into the future, we're stuck in the past. Health care is changing so fast. We want to meet our mission to provide exceptional quality, patient-centered care in healing environments, and our vision is to be the best place to receive care, to work and to practice medicine. We strive to meet our values every day. They are ICARE: integrity, compassion, accountability, respect and excellence.

"We put so much thought and refinement into what we do, and it continues to evolve," Cunningham said. "Quality comes first, with the right treatment at the right time every time. We want quality information and quality food."

Just as he began to talk about the year at a glance, lightning struck, thunder sounded, and the lights went out, as did the PowerPoint presentation. As emergency lights popped on, Holley Hudgins, marketing director, went to Plan B and handed out brochures of the annual report. After a few minutes, the electricity came back on and Cunningham continued his presentation.

He touched on fiscal year 2014 (which ran from July 1, 2013 through June 30, 2014) at a glance. The hospital had 2,902 admissions, 4,080 surgeries, 388 babies delivered, 48,147 outpatient visits, 3,008 EMS ambulance runs, 17,034 emergency care visits and 19,599 hours provided by auxiliary volunteers. All this was done with 100 medical staff and 189 registered nurses.

Cunningham noted the hospital had hired a new cardiologist and a new pain management physician.

"We endeavor to deliver as many services to the community as we feasibly can," he said. "We are having to look at everything carefully and focus on the core services, and do the best we can.

"Our engaged caregivers—how vital they are. How much we value them. How much we love then," Cunningham said.

He opened the presentation up to audience comments and questions.

A caregiver said she has been working at the hospital since 2000. "I have been training all over the hospital. We are a team—the doctors the nurses the techs and the secretaries. We can't do it without each other. The hospital is becoming more family-like, with help from other department. I hope we're giving the best care and getting better."

Another caregiver in education said she has a great job. "I get to find out information and pass it on. Everyone who wants to learn the latest and greatest can. We get information to the caregiver making sure the patient has the best care."

Wanda True, nursing director, said what she realizes and has known for a long time is "it takes a team to provide high quality care. It is ever changing, and we are learning every day to give the best quality care."

Two Barbaras spoke, saying collectively they have almost 100 years of experience. The first Barbara said Gila Regional is like "home to us. We've been a family for years and we're getting to be a better team all the time. I've been there almost 40 years. Retiring is kind of frightening."

The second Barbara said she grew up at Hillcrest Hospital and then went to Gila Regional. "I have seen it transform and it's awesome. It's home. It's where we have learned. I have personally grown there. I'm glad to be a part of it."

Cunningham said the hospital is made up of great people doing great things. "We did a survey and asked caregivers to score themselves. We asked them how willing they were to do anything asked of them. 73 percent scored themselves with a 9 or 10, 21 percent with a 5 to 8. They go above and beyond for 'you.'"

He noted that Housekeeping services had scored in the top 10 percent nationally.

Ralph Dominguez, who directs housekeeping, said his workers are engaged and willing. "They love what they do. We have the best maintenance crew in the state. We've gone a long way in the past year. It was a $10 million turnaround, and we've been running the past three months in the black. It has been described as driving along at 75 miles per hour and trying to replace a transmission."

"You mentioned transformational," Dominguez said. "It was certainly a transformation. We weren't going to lay off numbers. They were people. We tried to find places for just about everyone. The tools I've been given to be more efficient and effective have worked very well."

Cunningham said the plan has come together over the past 10 years. "Every conversation we've had has added to the plan. That was the reason we could implement it so quickly."

He said the Gila Regional Foundation has provided $3 million this year in equipment to the hospital.

"People talk about efficiency and effectiveness," Cunningham said. "We take it seriously. We are students of operational excellence."

Dan Otero, chief operation officer, said he was director of quality for four years. "I made the conscious choice to do consulting. I worked with large and small critical-care hospitals. I've never seen a result like what resulted here in the past year. It was a lean approach, developed internally and based on people. The leadership team continually asks questions, such as 'How can we improve?' We know there is so much more to do."

Cunningham said the hospital is using an innovative approach to nursing.

Gila Regional in the past year obtained and installed a linear accelerator.

"Our composite inpatient core measures have gone up this year," he said. "We are now at 98 percent. Our financials were negative $9 million at the end of fiscal year 2013. At the end of fiscal year 2014, we were at a positive $1.2 million."

Pam Archibald, who serves on the GRMC Board of Trustees in the financial committee, said: "I never dreamed it would turn around as fast as it has."

"We put in a team that brought the turn-around," Cunningham said. "The miracle was based in reality. We've been having dialogues for years, planning for years. It was Aug. 5, 2013, when we got the opportunity and went into implementation."

He said the daily spend a year ago was $191,000 a day. Now it costs $174,000 a day. "We not only drove the curve down, we broke it. Another common statistic is days of cash. At the end of fiscal year 2013, we had 109 days of cash. Last month, we had 128 days of cash. Now we have 142. This means that if not another dollar of revenue comes in, we have enough to last for 142 days. Of course, that's not what we want."

As for strategic future plans, the hospital has four physicians employed by Gila Regional. Hospitals and physicians always used to be separate, but "we see it differently. We are working on a project to start a family practice in Gila Regional."

He said Gila Regional has had a long-term issue with space for labor and delivery and the nursery. "We are starting to look at space analysis."

A question was asked about the rumor that people are turned away at the emergency room. "Not in any emergency room in the country can someone be turned away," Cunningham replied. "Anyone who comes into the ER, we will see, no matter what."

He asked for a comment from a member of the Collaborative Community Council. Dave Schwantes said he, as a member of the council, brings up what he hears on the street. "I tell people to go see the boss. I feel like I can give the correct information from what I hear at the council meetings."

Cunningham said Gila Regional is not in a place to be everything to all people. "We analyzed all departments and realized we could no longer do home health and hospice. Obviously, it was an important part of Gila Regional. Our hope was for minimal disruption for patients. There was no loss of services. Our first goal was that all patients have access to care. Our second was that our providers could join Gila Regional in another capacity or go to Horizon or AmberCare. Only five to seven ended up with no job. I think it will help sustain the organization's core services. The home health and hospice services are still in the community."

Otero said four of the seven turned down other jobs within the hospital. "We tried to be compassionate in the process."

Gila Regional Chaplain Bill Holguin said he knows Father Henry Hoffman, who is the Anglican pastor. "He went to work for AmberCare and feels comfortable there. He feels their care is excellent, and they are providing the best service they can. He's impressed, he told me."

Rick Vasquez said he's now a buyer for the hospital. "I was one of the caregivers caught in the reduction in force. All I could do was accept it. I appreciate your confidence when you told me 'this is not the end. Hang in there.' I saw it in your eyes. Since the leadership change, you have empowered all of us to be leaders. We have probably the best materials management team in the state."

"My confidence comes from you because I've worked with you for 13 years," Cunningham said. "I know what you can do."

Ray Goellner, chief of clinical services, said he has been a pharmacist for 41 years, and this is the eighth hospital he has worked in. I've never seen a turnaround from a $9 million loss to a $1.2 million positive in less than a year."

Omaira Heakin, chief financial officer, is the newest leadership team member. "My career has been in for-profit hospitals. This is my first in a non-profit. It's been amazing to see the vision of Gila Regional to be here for the community. My job is to make the financials to be as accurate as I can make them. This is one of best groups I've ever worked with, with its focus on leadership and empowerment. We know we are building something unique. I see this hospital as a stand-alone, doing amazing things. It's an honor to be part of this, and it is the beginning of so many great things coming to the community."

Heakin's young daughter Andrea said: "I'm really proud of this hospital." She said everyone should know what's happening. "You have to have a team and someone has to help you along."

Susie Trujillo, who has served at Gila Regional for 24 years, and is the community liaison, said she is proud to be an employee, working on building relationships with the community.