By Mary Alice Murphy

To begin the regular Governing Board meeting on Sept. 22, 2022, the board members recognized several Gila Regional Medical Center staff members for their years of service to the hospital.

Board Chair Alicia Edwards recognized Yolanda Travers for 10 years of service, now serving in Neuro Diagnostics; Ann Pavlakovich for her five years of service, now in the recovery room; Celina Shannon for five years of service in the emergency room; Dana Andazola for five years of service in the Family Practice; and Laurie Tavonatti for five years of service in emergency medical services. Each awardee will receive a certificate of appreciation.

With no public input, board members went into executive session for the next three plus hours.

Edwards noted that the only items discussed in closed session were agenda items and no decisions were made.

Board members approved the consent agenda of minutes from the Aug. 25, 2022 regular meeting.

Having no old business, they went into the items of new business.

The board members approved the Medical Staff Executive Committee recommendations for provider credentialing, as discussed in executive session.

Item No. 2 addressed a resolution for recission of specific agreements for Dr Stinar, Dr. Lamour and Agility Health, as they had not been finalized when approved. Members approved the recission to await the finalized agreements.

The next resolution accepted capital funding for $400,000 for a 3-D mammogram machine and $525,000 for a nurse call system.

The final resolution addressed Cancer Center practitioner agreements. Interim Chief Executive Officer Greg Brickner explained the agreements would keep the Cancer Center moving expeditiously to align hematology and oncology with hospital policy.

Members approved the agreements.

A professional service agreement considered was approved with One Click Physics LLC, for physicist and dosimetrist services to the Cancer Center. Brickner said the service will be part of the Cancer Center from a highly rated company for one year. "It was one month, but this extends it for a full year."

Members approved the physician employment agreement with Cherie Hayostek, M.D. as a radiation oncologist for the Cancer Center.

In the following new business item, members approved a physician retention agreement with Roberto Carreon, M.D., as orthopedic surgeon, to keep him working in the local market and at Southwest Bone and Joint Institute.

Members also approved a first amendment to the laboratory medical director contract with Pavel Capek, M.D. Brickner said it would give more time to get a new director in place. "He does a very good job," Brickner noted.

A memorandum of understanding with HMS for mammography screening gives the hospital back up coverage for mammography services. Brickner said it was a win for the community. "It helps HMS accreditation and it's backup for the hospital."

Members approved the MOU.

The next item addressed a capital purchase and service agreement with Hologic Inc. for 3D mammography equipment. "We will get it installed
as soon as possible, but it may take up to 90 days. We're not sure. It will increase the diagnosis capability and will allow follow up for the Surgery Department and the Cancer Center," Brickner said.

Edwards noted it was the only 3D mammography equipment in the area, so other providers can write orders for it.

Chief Financial Officer Patrick Banks said the hope is to allow the hospital to expand service beyond the current patients. Members approved the purchase.

The following item addressed the purchase of security operations center monitoring and management solutions with PC Connection. Banks said the cost is $9,000 a year and is required under the hospital's cyber-security insurance. "It offers real-time reactions to cyberattacks to protect the hospital." Members approved the purchase.

Members considered the renewal agreement for technical assistance, maintenance and support of network hardware, wireless access points and servers with Cisco Smart Net Total Care of PC Connection. Banks said it is the $77,000 IT contract. "We are comfortable with the services they have provided."

Board members also approved this agreement.

The final item under new business was a consideration of Exhibit A to the Master Agreement with BioEx (home exercise program) with Net Health Systems Inc. Banks explained it was an add-on for physical therapy. Members approved Exhibit A to the Master Agreement with BioEx.

Next came reports and updates

Chief Nursing Officer Melanie Vigil presented her report. She talked about swing beds, which have been discussed before. "We are restarting the program, so we can get it certified. We had our first patient in a swing bed last month. We are looking at every patient to see who is eligible for the program. We are working with the Joint Commission to get certification. The program allows a patient to meet therapy goals before discharge to home, whether it's after surgery, a stroke or an accident."

Edwards noted that it keeps patients in the community instead of having to send them elsewhere for therapy.

Vigil agreed and said it also includes those who might be in a facility outside the area. "They can come back here for the therapy."

She also said "Bertie" Berry is working on the trauma program. "She gives nurses more skills training. We are improving policies and procedures for health care. The staff is the reason across the system. We want to promote employees. In each department, we, in the leadership team, are rounding with patients every day. The employees note that we have their backs."

Banks presented the CFO report at the end of August. "Volume trends recovered in August from July. But compared to the prior year, they are still a bit low. ER visits have been running well above the prior year. Outpatient visits are up, and surgeries are above budget."

He said he wanted to highlight the negative 1 number in the EBIDA (earnings before interest, depreciation and amortization). "It actually excludes depreciation. But it is a recovery from July. As the years progresses, we look to bring some control to the contract labor situation. We expect it to improve EBIDA and our net operating position."

For the fiscal year-to-date results as of August 2022, the hospital reversed its performance to well above budget. "In the key measures of liquidity, we feel the hospital is in a strong cash position." The net accounts receivable days are down, as is the average payment period, both positive happenings.

Banks noted that a $1.5 million Medicare loan received early in the pandemic would be paid off in September, settling the hospital's debt liability that was planned for, but it will be a hit to the bottom line.

In the capital purchasing update, Banks said the hospital completed the roof replacement, as well as all the reporting for the grant. "We're happy that it lasted through the rainy season, which may or may not be soon over. We're thrilled with the grants for the roof and ambulance. But we're pleased that with the cash, the hospital has put smaller amounts into repairs, upgrades and maintenance. We have put $2,037,204 total into the hospital in the fiscal year 2023 to date."

Governing Board Vice Chair Billy Billings thanked Banks for the new roof. "It was so needed, and it looks nice, too."

Edwards presented the Chief of Staff report in Dr. Brian Robinson's absence. It consisted of the credentialing report, which was discussed in executive session and had earlier been approved, and no other updates were presented for information.

Chief Quality Officer Ramona Wilson gave her report. "We are developing a holistic approach to transforming patient care as well as the patient experience while they are at Gila Regional. We are utilizing our Press Ganey survey. One of the questions we are focusing on is likelihood to recommend. We are using it to recognize recurring themes in meeting our patient expectations. We are reaching our goal through Press Gamey education of directors and managers and developing action plans in the focused areas. One thing we discovered is waiting times, and communication to the patients and families and the comfort of the areas where they are receiving the care. We are also sharing positive experience to our staff. Employees need to hear that feedback. Usually, we're focusing on the negatives, but they are doing such great work that we're highlighting the care they are giving. We have implemented leadership rounding. We're looking at what is our patient telling us, so we can meet the needs of our patients in real time. Our patient liaison Valerie Johnson is also the chair of our patient experience committee, along with Heather Morrison-Bean, who is our ER director. We have updated the GRMC website with Valerie's contact information, so if there are concerns within the organization they can be directed to Valerie, so she can address concerns in real time. We are also collecting data from the patients' responses and feedback The patient experience steering committee has Dr. Robinson as the physician champion."

She said infection prevention has been implemented, with the first flu clinic giving out 87 vaccinations for the first round. "That is a bit less than 20 percent of our staff, and our goal is 80 percent."

Wilson said the education department is moving from the Billy Casper Wellness Center to Gila West to make them more accessible to staff members for books and classes.

Chief Human Resources Officer Beverly Bush presented her report. She said the hospital would go live on Sunday with the Ultimate Kronos Group. "We will have trainings for Meditech with UKG for directors, managers and timekeepers. The first punch of the new timeclock would take place on Sept. 25, with the new pay statements on Oct. 14. We have conducted training on the new timeclock for about 150 employees, so far. The next thing we are rolling out is the employee engagement survey from Oct 11 through Nov. 1. Our goal of participation is 68 percent with a stretch goal of 73 percent. Each person will have a unique link. Fun snacks will encourage employees to participate."

She noted the hospital had hired 9 new employees in August, with 8 terminations, bringing the total number of paid full-time employees to 405 and contracted travelers to 25. To finish out the year, September to October will be the rollout of UKG, October the rollout of the Press Ganey employment engagement survey, November with open enrollment and December with merit evaluations.

Edwards noted that the budget includes funds for merit increases, and Bush said they want to continue those increases.

"How much have we invested in employment salaries increases over the past 18 months?" Edwards asked.

Banks replied that since the first of the calendar year 2022, the total is over $1 million. Brickner said he would guess for 18 months it would be about $2 million, close to $3 million that "we are reinvesting back into staff."

Brickner then presented the CEO report. "We are busy at the hospital. The hospital never closes, and we are working on the car as it is going down the road. The nurses and physicians are doing the quality care. Behind the scenes, the support staff is working to give the providers the tools they need for excellent patient care."

He said he had created an organizational chart to make sure all the teams are working in alignment with one another and to have the reporting structures that are necessary for complete communication, which is the key tool.

Brickner said over the past month an employee newsletter had been created, and he had held town halls for all employees. "We also resumed monthly director meetings. There is friendly competition between the directors."

He said 11 hospitals in the state are cutting staff, but "we're hiring. Please visit the website to join our team." The website is grmc.org.

"We are trying to focus the teams to key projects, so we can complete them and get them across the finish line," Brickner continued. "The Cancer Center is key. We are bringing the service line back in-house. Dr. Hayostek, radiation oncologist, whom you just approved, starts Oct. 5. She will support about 20 percent of our patients. We are working on building up the staff and to allow backup. The agreement to allow Chair Edwards to sign agreements allows us to bring items to closure more rapidly."

He said the swing bed program helps keep patients local, and even those that go outside the community can come home to Gila Regional before being discharged to their homes. He said it takes stress off family members, who will be able to visit them at GRMC rather than having to travel to Las Cruces or El Paso.

"The upgrade to UKG is six years in the making," Brickner said. "This begins to modernize our HR function. The job applicant will type in their name, and it will become part of their record, rather than the duplications that we do now."

He reiterated that the patient experience that Wilson had mentioned is key to the hospital's success. "We have built a cadence of rounding, where our leaders are visiting our staff members, and the staff members are visiting the patients. I'm starting to round to as many of the new patients as I can. It's becoming one of the bright spots of my day. Most of the feedback we get is positive, but if we get negative feedback, we can correct it quickly. It will streamline the process, while increasing the patient experience quality."

He said all of the work will translate into the revenue stream, with the expansion of services, and most importantly providing excellent patient experience.

Brickner said the Bayard building, once used by the hospital, has been turned over to Bayard. The hospital has also gotten rid of some old ambulances.

He noted that this year the annual Halloween Trunk or Treat is back on Oct 31.

No one attended to give the Health TechS3 report,

During board comments, Billings thanked the staff for organizing the patient experience steering committee. "I recently had an experience in the ER with a family member. We all noticed something in the ER that was better than we had seen in about 40 years, and it was the care we got. You're going to the ER to have your clinical needs met, and they were. Then there's the human part. People want good service, whether they are at the bank or the hospital. They want to be treated well. I felt good about the positive interaction we had with 8 or 9 staff members. We can tell the change in morale and training. So, I compliment you and the ER director and the whole staff. One tech came to get our family member for a CT scan, and when she brought her back, she asked if she was comfortable, if she wanted a heated blanket. Lots of human reaction. All of us also look forward to timely treatment. I'm guessing there were about 40 people in the waiting room that day. As I walked back, it seemed like every room had someone in it. This morning, I had a test and met a relatively new employee, very professional, nice and let me know what was going on. I watched my heart, and the explanation was way over my head, but you could tell the staff member was excited about her job. It makes me feel positive about the direction of our hospital, so thank you."

Governing Board Member Javier "Harvey" Salas said it's fixing the small things that made a difference. "Mr. Brickner, I like your positivity, and we are heading in the right direction. I want us to be the gem of the Southwest."

Governing Board Member Chris Ponce also thanked Brickner "I have heard compliments on Denice, Beverly, Ramona, Melanie, etc. I appreciate all of you. I appreciate what JoAnn does and we appreciate all the staff."

Browne said he has good feelings about the hospital.

Edwards said that in the past two or three months, "it's like everything is reaching a tipping point to the positive shift, so thank you all for all your contribution to that. I, too, thank JoAnn for all she does."

Edwards said she had a "big ask. In my inbox this morning I found this thing. It's called the Step Up Foundation that works on veteran mental health. They do this event called the Chad 1000X, named for a veteran who took his own life on October 29, 2018. It is an individual or a team challenge to do 1000 box steps. The most difficult is the one with a 40-pound backpack on your back with a 20-inch box step. You can also do the Slick one, with no rucksack and you pick the height of the step. I suggest we five members of the governing board, and all of you in administration and the C suite, and including JoAnn, do this challenge together as a team to raise some money for the foundation. It happens on Nov.12. I will be in touch with you. It's a thousand steps all together, so we could each do 100 or something like that. If you have ideas, let me know. Maybe we could get everyone in the hospital to do it or something crazy."

The other thing she wanted to talk about was that she just got back late the previous day from the Health TechS3 governing board conference. "It's the second one I've been to. Mr. Browne, Mr. Salas and I went to the one in Santa Fe last year. It was kind of eye-opening. I think Denice might describe me last year when I came back as in kind of a panic about quality, because we took this survey. It was about how much the governing board knew about quality. I only answered one question in the positive. We've made a tremendous amount of progress since them. It's quite interesting listening to what small rural hospitals around the country are seeing and doing. Others are facing the same challenges we are. We are in a really good shape compared to some other rural hospitals. The first two quarters of 2022 were the worst financial quarters ever for rural hospitals. I think being able to look at our financials and know that we are not there was good. It's pretty scary what people are talking about. The focus of the conference was the changing culture with the theme 'What's going to happen to health care post Covid?' Everything has changed and how it will manifest itself over the next 3-5 years will be a big challenge. We're lucky, I think, in that we're kind of starting over anyway. For a lot of them, they are not in the starting over phase, but in the 'holy crap, what just happened?' phase. They don't know what they are going to do. We have been talking about our governance. We know the commission members cannot do this forever. It's bringing up what I have given to my fellow governing board members. It's called Via Health Care Consulting. I met them when they presented at the conference. What they presented was transformational governance. I was so excited about it, I engaged Mike Lieb and Scott Shanker in a conversation about it. We are going to put together a governance retreat. I will talk with the governing board members for maybe a retreat in the last week in October. My goal is to have an ongoing conversation over the next year or two on governance and how we do a culture change so that the governing board can assist the hospital in making that change and bringing together what we're all already talking about today."

The meeting adjourned.