[Editor's Note: This is part two of a multi-part series of articles on a Gila Regional Medical Center Board of Trustees regular meeting July 28, 2017.]

By Mary Alice Murphy

After approving or tabling some of the consent agenda items at the Friday, July 28, 2017, meeting, the Gila Regional Medical Center Board of Trustees agreed to put off approval of the rest until all members had a chance to review them, during the recess between the regular meeting and the executive session.

In reports and updates, the Auxiliary report was in the members' packets, but the president of the Auxiliary, Frances Day, was not available to highlight items.

Chief Nursing Officer Peggy White said the Auxiliary had helped in weeding out some of the clothes in the emergency supply for those who come into the emergency department. Because of injury or trauma many have to have their clothes cut off or for another reason cannot go home in their own clothes, they receive clothes from the emergency supply. White said Day is the point of contact for anyone wanting to donate clothes. "The Auxiliary accepts donations and gets them cleaned."

Again, no one from the GRMC Foundation had sent in a report on the group's activities. "We are trying to team up with the foundation," Board Chairman Jeremiah Garcia said. "We want them to be a partner with us. We appreciate what they do."

Trustee Tony Trujillo agreed the foundation is an important component of the hospital. "We'll keep trying to get someone here. I'll try again. Even if we can hear from them quarterly."

Chief Executive Officer Taffy Arias gave her report. She separated it into service, quality/safety, finance, growth and people.

"Everything we do falls into service," Arias said. "The Cancer Center is happening quickly. We have six caregivers, two University of New Mexico physicians have been credentialed and others are being credentialed. We are also doing interviews for locums to temporary assignment until full-time providers are hired, and the UNM leadership team was on campus on July 14, 2017 for assessment of equipment and to meet staff. All capital equipment purchases required for the change over have been approved by the Board of Trustees, the patient record transfer is underway and patients are being contacted for continuance of care. We have physicians who will return to Gila Regional on Aug. 11 to create processes to resume care. Local physicians are working with oncologists to maintain some patient services at Gila Regional until the complete program is implemented. Marketing is underway highlighting staff and their expertise."

Under quality/safety, Arias said: "We have entered a journey of high reliability by reducing variability. We are reviewing the systems, so we know every step of the process. We have daily safety huddles initiated with senior leadership, which will be initiated in every department and clinic for effective results. The Every Patient, Every Time program is being developed, so that every patient receives the same care every time. 'Hardwiring Excellence' is underway, because we must hardwire our practices, so there is no variance."

In finance, Arias said all areas of the hospital operations are being reviewed. "We are reviewing supplies and will review the inventory every six months. We cannot afford stockpiles and we can't allow items to go out of date. Negotiating with current and future vendors is in progress to provide us buying power. We are looking at every contract vendor and every service line to make sure we are making money. Some service lines can lose a little bit, but we must cover them with service lines that make money. These service lines include the clinics affiliated with the hospital. We are looking at the Finance Department. We must have better processes. We must make sure all positions work at a high level. I'm held accountable every day. I have to justify being here. I want to make sure the justification is there for everyone here."

"In growth, we have to grow volume," Arias said. "We must grow the clinics. We are looking at why so many people are being transferred out of the emergency department, to where and why? Every single transfer has to be approved by an administrator. We are looking at those leaving the ER and why and what the length of wait and stay is. We are reviewing out-patient testing and the surgery volume."

Under the topic of people, Arias said the hospital will interview a general surgeon and will interview for a permanent chief financial officer. "The Chief Nursing Officer Peggy White and the Assistant Chief Nursing Officer Kelly Rodriguez have truly stepped up to the plate for our organization. Kelly has stepped forward to help the Cancer Center in the interim."

Garcia said he had heard people in the Cancer Center ask: "Can we keep her?" to which White quickly replied: "No."

Newest Trustee Jeannie Miller asked what the different service lines included. Arias' list included ob-gyn, surgery, radiology, orthopedics and cardiology. "They generate revenue. We have to make sure the service lines and clinics are making money."

Garcia said the service lines contribute to the hospital by getting services, such as lab tests, radiology and pharmacy at Gila Regional.

"All have to be looked at for productivity," Arias said.

Trustee Mike Morones said he assumed the hospital is looking at the service lines in relation to the demographics and what the hospital has and what it needs.

"We have to look at the payer line," Arias said. "Are the services justified or not, but needed? We don't want too many not making money. We want to be bringing in new service lines to meet the needs."

White said inpatient numbers were averaging 20-24 a day.

"We have to determine how to keep the doors open," Garcia said, "and clarify if we're making money or not, and if we can afford new service lines."

"This hospital cannot survive without the support of the community," Arias said. "We have to support our excellent caregivers."

Morones said talking about positions brings the discussion back to the RIF (reduction in force). "I want to challenge the CEO to give any justification if we have an RIF. I hope you will have a strong, open justification. When we did the last RIF, we lost some top-notch people. It's important to keep the good quality ones."

Assistant Vice President of Administration Liana Ryan said of the initiatives the hospital had begun in January, "58 percent have been completed. We started with 20 and added four more. The collaboration with cardiology and imaging has been completed. We have started working with United Health Care, from which we will receive about $25,000, but not for a year for the clinic. We have established the process to bring the EKG readings in house, which will give us about $40,000 in savings. Recruiting will reassess to determine the right providers for services."

Trustee Joel Schram noted that the initiative that would bring the largest revenue was only 5 percent complete. "We wanted to have a full-time CEO before we implemented it. It is tied into compensation packages. We will participate in incentives. We will strive for a value program for medical providers to align our goals with attainment."

Miller asked about rural care status.

"The Gila Family Clinic is eligible, but the hospital has to have fewer than 50 beds," Ryan replied. We have 64, but Peggy has an initiative to turn many into private rooms."

"All insurances are now paying on quality and value, not on volume," Ryan said. "United Health Care gave us the elements needed, and we were able to realize meeting those elements. UHC will collect data and assess it and will ultimately pay us more."

Miller asked about the Prolia injections and why the increase suddenly. (Prolia is used to treat osteoporosis in post-menopausal women.)

"We did a financial analysis and started with a few patients," Ryan replied. "We have 24 initiatives, and so far the impact from the completed ones has been $205,000."

Trustee Tsering Sherpa asked about whether anyone was in the pipeline for an ENT (ear, nose and throat). Ryan said the one who was interested had difficulty getting documents to the hospital as well as getting a New Mexico license.

"We will reach out to recruiters," Arias said.

Garcia asked why only 45 percent completion on the coding initiative. Ryan explained a billing person is actively doing the training, but she diligently works on it only when not at her job.

"We have had a few hiccups on the Meditech 6 upgrade in being able to populate documents," Ryan said.

Garcia complemented the team for reaching out to Freeport McMoRan Inc. for the hospital to provide services to the company's employees. He also asked how soon a pediatrician would be on board. Arias said the one that had been in the pipeline withdrew her application and took another position.

"We have physicians who have stepped up to fill the gap," Garcia said.

Trujillo asked about whether the hospital had the Veterans Choice designation. "It has been on hold."

"We were attempting to do it, but once we looked at the amount of work required, it would impact every department," Ryan said. "We wanted to make sure the departments were focused on Meditech 6. Once we get the technical bugs worked out, we will return to it."

Trujillo noted it would give the hospital opportunities to provide services to veterans.

Ryan agreed and said it would put the hospital first on the list if veterans wanted or needed to stay closer to home.

White in her report said several projects in the nursing department are on hold because of Meditech. "I will feel more comfortable working on them on the other side of the bugs. We will work on a strategic vision for nursing."

Miller asked if the goals were agreed upon in the recent board strategic planning session for all departments or just for nursing.

While said what she had in mind were goals only for the nursing department. "We've done some strategizing within nursing department. Everything nursing does affects the entire hospital. We meet every Monday and with the directors every month. It helps me to track where we are. My next month's report will focus on seven key points that I want to focus on for the rest of the year."

"When will we look at a stroke center?" Garcia asked.

"It would require affiliation with another facility," White said. "I have been meeting with the team. The transition in the ER to a new director is a big part. The new director's goal is to have certification for strokes within the next year. We are making big pushes, because if we can keep patients here, it's a big benefit. Often patients that transfer out to another hospital don't receive any care we couldn't do here. Trauma is different, depending on the level."

The next article will continue with the leadership reports and go into committee reports.