[Editor's Note: This is the final of two articles on the GRMC governing board August meeting. It covers more reports and agenda items.]
By Mary Alice Murphy
To read the CEO and CFO reports, go to https://www.grantcountybeat.com/news/news-articles/67133-grmc-holds-governing-board-meeting-082621-part-1.
After hearing the financial report at the Aug. 26, 2021, meeting, Gila Regional Medical Center governing board members heard again from Interim Chief Executive Officer Scott Manis presenting the HR (human resources) report.
"Before I talk about our work force, I want to add a relevant element to Greg's (Brickner, interim chief financial officer) report," Manis said. "We had a number of conversations last year about the hospital financials having an impact on the county bond rating. The hospital generates about $70 million or so and the county, which owns the hospital, generates about $30 million or so. With the financial improvements at the hospital, getting back in the neighborhood of where we need to be, with a bright future ahead, it will help the strength of the county's bond rating and not compromise that at all. The financial performance of the hospital is inextricably linked to the county."
Chair Alicia Edwards, who along with the other governing board members, is a county commissioner, said: "With our county hats on, we appreciate that also."
"I want to go into more discussion on our GRMC Workforce Initiative," Manis said. "Over the past two or three months we have taken a deep dive into this. As your CEO, this is my No. 1 priority. We're talking about it in four different aspects."
He talked about the situation nationally. "With Covid, in particular, the demand for nursing positions is great." The chart he showed also noted the traveling nursing demand, which has also increased.
Manis said the hospital works with a recruiting clearinghouse on nursing and traveling nursing. "The demand early last year scrambled for traveling nurses. It dipped a bit, but with the past three months and the growth of covid cases has jumped higher than the peak last year, the demand is extreme. Not only the small hospitals, but also the large ones, we can't produce nurses fast enough, and they are a resource that all of us need. The demand outstrips our needs. We are recruiting one another's nurses. When I talk to our nurses, I ask them, and they say they are getting so many calls from hospitals all over the country—daily—from the recruiting companies. This is the proxy for all positions across the company, not just nursing."
The New Mexico Hospital Association sent out a survey to which 37 of the state's hospitals responded. "I asked for the data as quickly as they could get it to me. Again, looking at nursing as a proxy for all positions, our numbers are similar to these results. On average across these 37 hospitals, only 71 percent of nursing positions are filled by their own employees; 12 plus percent are filled by travelers; and 17 percent are vacant. Most folks see it getting worse. We're all facing the same challenges."
He also said the Beckers Hospital Review had talked about average hourly wages across the country. "It ranges from $34 an hour to $54 an hour across the country. That's not where we are today. We are at the low end. We want to look at moving that up. When we look at travelers, rates have become almost an arms war. Traveler companies won't even talk to us if we're not offering enough. Right now, we're offering about $120 an hour. And that's just barely getting attention right now that would consider coming to Gila Regional."
Governing Board Member Chris Ponce noted that the amount is not solely the wage but is what the company charges. Manis agreed and said it will cover the wages for the nurse, the expenses for the nurse's lodging, per diem, traveling and the costs of the company to do the recruiting and arrangements. "I would tell you the numbers were in the $80-$90 at the high end a year ago. The companies are paying the nurses an enhanced wage, but not that full amount."
"So, what are we doing for this?" Manis asked. "Our workforce initiative we've taken very strongly in focus by the administration. Our focus is on retention, to keep the good people we have. Then it's recruitment, culture and morale, and we're working on the perception of the viability of the hospital. If we can't change the perception in the long haul, people will say 'why do we want to go there? The doors are closing.' That presents a challenge for us continuing to put out our own story. We currently are experiencing very tight staffing. Our overall vacancy rate is about 15.4 percent, but our nursing vacancy is about 20 percent. We have 19 open nurse positions, which represent 16 FTEs (full-time employees). From a traveler position in the last calendar year, we averaged about 8 travelers, not just nurses, but in the lab, X-ray and a couple of others in the hospital. We started this year at 9 and it has continued to increase. Right now, we're sitting at 19 travelers. That is a lever we are focused on reducing. Some of the things we are doing is re-evaluating our pay, focused around retention. The surveys and the meet with the CEO are other things we are doing to get information on how things are going. We are also thinking about an incentive pay for taking extra shifts. We'll kick that off in the next couple of weeks. We want to get nursing salaries into a higher range. We're working diligently on that. We are now able to reinvest in our wages, in our hospital, because of the positive finances we are demonstrating. In general, over the hospital in general, there have not been merit increases or cost-of-living increases over the past six or seven years. We will continue to shore that up across the entire hospital."
"I will add that we have merit increases in the budget," Manis continued. "We will have them targeted for January. So, performance across the hospital will affect those increases."
Chief Nursing Officer Kelly Rodriguez presented her report. "As has been alluded to already, across the United States, the decreasing number of nurses available to our area makes it difficult to address some of our quality initiatives. Our nursing directors are working the majority of their time also as staff. We are trying to work with creative staffing and directors are working as staff, all to ensure our safety of patient care. We work within matrices and ratios for patient care. We have to continue doing that for safety of patient care. Over the course of the winter, we will continue to evaluate. We meet every morning and discuss the hospital population, the acuity of needs, and we make decisions to either have someone go home to bed and return that night. Covid is having a resurgence and we are seeing Covid or flu-like symptoms in our emergency room. We have gone back to our surge plan in preparation. Our hospital has been full, and then some, every single day. So, we make those adjustments and offer incentives for our staff to come in and work extra shifts."
"Looking at our ED throughput on our decision-to-admit times, which we will restart on Sept. 13," Rodriguez said, "our goal is 30 minutes from the time the person receives medical orders to the time they get to their medical/surgical bed. Depending on bed availability, if we cannot find a bed for that patient in the med/surg unit, they will transition into what we call an ED hold, where they will be cared for as a med/surg patient until the time a bed is available. Going along with this, we look at least a day before or even two days before at our surgical cases. Most of these are elective surgeries so we continue to evaluate depending on bed availability. As we get the time down waiting for a bed, that will decrease the number of patients in the waiting room, so they are not stacking up. We did change our visitation policy. We had opened a morning visitation, but we have had to close that. So, visitation is now from 4-6 p.m. for inpatient units. We did not change our ER visitation, where a single person is allowed with each patient, but we did change our OR (operating room) policy. We are not allowing family members into the pre-op or PACU (post-anesthesia care unit). They must wait in the waiting area. To continue talking about our efforts, of course, we work on recruitment with Western New Mexico University on their graduating nurses. Come December, they will have 31 graduating nurses with their bachelor's degrees. We are excited about that. We will meet and greet with them on Sept. 22. We will continue to have events for them throughout the year. We also visited Thatcher because Eastern Arizona College has a nursing program. We plan to reach out to their graduating nurses, too. Additionally, good things are happening. We already have a number of nominations for our Daisy Award. We will be awarding a nurse with a Daisy Award again this year. I've been asked to speak at the Rotary in September about nursing. Last, but not least, I try to recognize a nursing employee. I would like to talk about Lelania Maynes. She does an amazing job in our Beginning Years Program. This woman knows her stuff, inside and out, backward and forward. She keeps it running in compliance with our grant."
Ponce said it's not so much a question: "Thank you for everything you do. You have 19 open positions for nurses. That's pretty significant for a hospital that size. Some public doesn't listen to us, but we ask you to be patient. We ask you to have patience with the staff at the hospital. Certain things take time. The other piece, I don't think the public realizes the things that happen at other hospitals, whether in the state or elsewhere, don't necessarily happen here. If we don't take care of ourselves and use precautions, other hospitals are filling up, too. So, there may not be a place to send someone. I ask the public to keep this in mind."
Rodriguez agreed. "The pharmacy director sent me a little sign that said: 'Be kind to the people who showed up today.' It's kind of funny, but it's true. It's very stressful not being able to pull someone back for treatment who we know doesn't feel well, but behind that closed door is a ton of other patients who also feel bad or worse. We're lucky, knock on wood, that our waiting times are not the 20 hours that you might see somewhere else. But what we're facing, we may not have a place to send you. There have been cases of not being able to send a critical patient out because there are no accepting facilities available. Our house supervisor who oversees the transfers is calling as far away as east Texas or all the way to Denver. We had a time where we had to call as far as Las Vegas, Nevada to send a critical patient. We try our best every single day and we ask for that patience."
"We appreciate everything you are doing," Ponce said.
"We have an amazing nursing staff and administration," Rodriguez said. "We have an amazing hospital."
Governing Board Member Billy Billings echoed the thank you to Rodriguez.
Edwards said she appreciated Ponce bringing up the issue. "I was thinking along the same lines. I just want to add that you [speaking to Rodriguez] rarely include yourself in everything that you do. We really appreciate what you do, and we know the challenge you are facing. We know that you are doing all your administrative work and doing bedside shifts to keep things going. We deeply appreciate everyone at the hospital. I would reiterate, as a community, I always hear great things about our patient care, but I also hear so many negative things about our hospital, because of long waits. We all share in the responsibility for keeping our little hospital going."
Manis presented the chief of staff report on behalf of Dr. Brian Robinson. He reported the Medical Executive Committee had met and reviewed as well as approved 17 managed care contracts, such as for anesthesia, the emergency department group, food service, and the hospitalist group, and any other entity that has direct contact to patients. "It is a requirement of the Joint Commission that the medical staff and the governing board review and approve the group services that work at the hospital. Approving their report would be acceptance of that list. The credentialing was presented to you during the executive session. The Bylaws Committee, which has a couple of new members, met to kick off their new group. The other committees have meetings set over the next 4-6 weeks."
HealthTechS3 Interim Services Vice President Mike Lieb gave the management report.
"I'll be brief," Lieb said. "You've heard really good stuff today, as well as some significant challenges. You've underscored that everyone is working really hard. The financial turnaround truly has been dramatic, which is enabling the Gila Regional staff to shore up the clinical services, the quality programs and start new initiatives. Frankly that also applies to you folks," he said to the governing board members. "You're doing a double job. Everyone else recognizes how many hours the five of you have spent, and we're appreciative of it. We still have a lot of work to do. We are kicking off strategic planning over the next few weeks. We're at the point where we can go forward. I think you heard me say that we got the patient [the hospital] off the operating table a couple of months ago; now we're doing the rehab and going forward. The CEO search is well on its way, and we'll be getting candidates to you soon. Our goal is to have a permanent CEO seated here before the holidays. Greg, Scott and Kelly have said everything else I needed to say."
No one had questions, but they all thanked Lieb for his presentation.
As the agenda had no old business, the members moved onto new business.
The first item was to consider approval the hospital's ICIP (infrastructure capital improvement plan) for fiscal years 2023-27.
Brickner noted that the No. 1 priority is telecommunications. "As we dug down through it, we are unsure of what we can accomplish. The fiber between the hospital and the Billy Casper Wellness Center, a lot of it is a recurring cost. There will be a hardware component, so that it can work with our internal system. But we don't have an estimate on the cost of a fiber ring."
He said the hospital has a lot of priorities and Priscilla Lucero (Southwest New Mexico Council of Governments executive director) helped them with the ranking.
Ponce noted that No. 10 in the list is the labor and delivery renovation, for which there has been some funding received.
Brickner said Lucero had recommended they keep it on the list because "it hasn't happened yet. That's why $2 million is in the funded column, but the $500,000 is a contingency."
Ponce asked if it could be completed with the funding received.
Manis said: "We believe the money we have is sufficient to complete the project. Priscilla said there may be some money targeted specific to women's service line, so she recommended we put there if there is money toward women's service line available."
Ponce asked about the $400,000 for medical equipment. Manis said the item continues to be in the ICIP each year because the hospital always needs medical equipment upgrades.
The governing board members approved the ICIP after striking No. 5, the fiber ring, and moving the others up one notch.
Members approved the credentialing report, which they had reviewed in executive session.
Manis explained the changes to medical staff bylaws, rules and regulations. "It's a very simple change, but important for our medical staff credentialing. Currently the bylaws refer to ACLS, advanced cardiac life support, they call out ACLS. There is also advanced life support (ALS). They are interchangeable and acceptable. So that is the only change there."
Members approved the change.
The next motion combined two items, consideration of the professional services agreement for EKG interpretation with Colicia Meyerowitz, MD, and an addendum to the nurse practitioner employment agreement for EKG interpretation with Erin Kleismit, NP. Manis noted that it expands the number of people who can do EKG interpretation to six. They are paid on a daily basis at a flat rate of $125 for however many interpretations they generate in a day.
Members approved the two agreements.
The next agreement was a renewal of the professional services agreement for on-call specialty service coverage for Gregory Iwaasa, DPM. "It's a four-year agreement," Manis said. "He loves the community and wants to remain part of the hospital. The compensation will remain the same." Members approved the agreement.
The following item was an amendment to the master agreement and related attachments for the BD Pyxis Medication Dispensing System through CareFusion Solutions LLC. Brickner said it is the equipment used between the pharmacy and nursing. "It will be an upgrade." Manis said the upgrade is already underway and "we plan to have it implemented by the end of December." Members approved the agreement.
A resolution was approved because the hospital requires the resolution in order to pursue funding assistance through the application for funding from the USDA Rural American Plan Act, according to Brickner.
The final resolution was for purchase of an EMS (emergency medical services) transportation vehicle. Brickner said all the EMS equipment is aging. This vehicle, which will be used for transportation will cost up to $100,000 and "we will pay out of cash." Manis said the vehicle is licensed as an ambulance, but it is actually a transit van.
Members approved the final resolution and adjourned.