By Mary Alice Murphy

Gila Regional Medical Center Governing Board Chair Alicia Edwards at the GRMC Governing board meeting on Dec. 8, 2022 recognized Sarah Jensen for her five years of service in the intensive care unit.

"I always appreciate the time, energy and dedication of the staff at Gila Regional," Edwards said in recognition.

After an executive session, the governing board members came back into session having made no decisions during the closed session.

With no old business, the members dove into new business. The first item approved addressed the credentialing, which they had discussed in executive session.

They also approved the professional services agreement for the medical staff leadership and medical staff committees., which would be listed in the Chief of Staff report.

The members also approved the first amendment to extend the physician employment agreement with James C. Rosser, MD. Interim Chief Executive Officer Greg Brickner confirmed that it was an extension with the same terms that all providers have.

Members considered and approved amendment No. 1 to a professional radiology services agreement with Imaging Associates of New Mexico LLC. Brickner said the coverage would be changed to one day every other week, because "right now, we have only an average of 4.5 patients a week."

Chief Nursing Officer Melanie Vigil confirmed that it was for interventional radiology, which is a guided procedure using the CT or MRI machines to perform diagnoses. Radiation is through the Cancer Center.

Member Billy Billings asked if the hospital does radiology services separate from this interventional radiology.

Brickner said most other similar services are done remotely by most hospitals across the country. "Our images come off our machines and are read remotely. This interventional radiology service is going from three days a week to one day every other week. They said nine in one day is doable. Every day we are fighting to save our services. They told me they couldn't do it anymore. I thank Dr. Dalton for helping me during that negotiation to get at least that one day every other week to keep the service."

Edwards asked what it requires that the hospital cannot do in house.

Vigil said the guided procedures require a specialized radiologist to be on site to do them. "They are all scheduled. It is rare to need it immediately, so a transfer would be rare. We still do CT scans and MRIs in the hospital. We are not losing emergency CT or MRI services."

The following item considered the purchase and license agreement with Mosaiq Plaza Empower and renewal of the electronic health record system for the cancer center with Elekta, Inc. "We are renewing some services and replacing some services and purchasing new modules. It is part of our insourcing of the cancer center. It expands our software, because cancer center outpatients require specialized software. It allows everything to talk to our Meditech system, the same as with Mosaiq.

Members approved the purchase and license agreement and the renewal of the electronic health record system.

The resolution of the construction plan for the labor and delivery improvements was approved. Chief Financial Officer Patrick Banks said the hospital is working with the state CES (Comprehensive Educational Services), which provides purchasing power for entities within the state. "We will merge the labor and delivery services into one section of the hospital."

Member Chris Ponce thanked Vigil for working hard on the issue. "I really appreciate it. We've been waiting forever."

Edwards also thanked Brickner and Banks for giving the tour of the area to state Sen. Siah Hemphill and Rep. Luis Terrazas.

Banks asked them to consider a designee to sign resolutions 2022-25, 27, 28 and 29, so they would not have to wait until the January meeting. Because Edwards was going to be out of town, the designee chosen to sign the items was Vice Chair Billy Billings. The other three items are approval of the employee health, wellness and benefits plan, the capital purchase of a urinalysis analyzer and the insurance plan to supplement the previously approved project with EZ-ERC.

Banks said they expect the documents before the end of the year.

Resolution 2022-26 proposed rescinding the IBM Service Elite $55,000 contract approved in October. Banks said it was a "housekeeping issue. The vendor determined that the equipment will be obsolete in the middle of the year. If you rescind it, we will provide a lower cost temporary period contract until the cut off time."

"We made a few changes in the plan in Resolution 2022-27 that I would like to point out," Banks said. "In the employee plan, we added a fourth tier to allow a parent and children to have an appropriate rate rather than having to sign up for the full family plan. The second thing we did, in an environment where premiums are rising across the board about 6.5 to 7 percent, we kept the rates flat this year."

Members approved the employee health, wellness and benefits plan to be signed by the designee when the document is available.

The next item under consideration was Resolution 2022-28 for the capital purchase of a urinalysis analyzer. Again, it will be signed by the designee, Vice Chair Billings, when the document is available. Members approved the purchase.

The last Resolution 2022-29 addressed approval of an insurance plan to supplement the previously approved project with EZ-ERC, a contract also to be signed by the designee.

Banks said it addressed a Covid aid package, which wasn't widely used when it came out, was improved in 2021 and has become available in 2022. "We expect it to be a significant source of cash flow for the hospital. It will compensate for and replace some losses during the pandemic and help bolster our cash reserves. We will take the insurance plan because it is a filing to the IRS to amend previously filed forms 941, which is the payroll tax filing. If you can get insurance, it removes risk from the transaction; we want to rely on it 100 percent, so that's why I recommend we take this policy."

Members approved the policy.

Vigil presented the CNO report.

Edwards commented on the photograph, which she really liked. Quality Director Denice Baird said the photo was by Anthony Howell, as are all the photos in the board room at the hospital, taken between Safford and Mule Creek.

Vigil said the hospital is doing a trial on the Covid-19 booster shots. "In the past, we offered the first shots to our employees, but after that, they had to go elsewhere to get them, so we are offering the boosters to employees, physicians and even patients, as of Dec. 12."

She noted they had done an employee engagement survey. "Our goal was 65 percent and we achieved 79 percent. The national average was 68 percent, so we were really excited to see the high percentage.
We celebrated by bringing in food vendors for lunch and for an evening meal."

The next topic she spoke about was patient safety. "That's our No. 1 goal. The biggest risk is falls, so we are re-implementing our fall program. We made a change, as of Dec. 1, when it became site-wide, not just the inpatient side of the hospital. We began in the ER, where they identified people at risk and put a fancy yellow wrist band and yellow socks on them. To go along with that, our Trauma Coordinator Bertie Berry has been working with some of the clinics to provide education to them. We're also providing educational materials to businesses so we can identify those who are at high risk of falls."

Governing Board Member Harry Browne asked if patients had protested being identified with the wrist band. Vigil said, with education, she had not found much pushback from those having the wrist band or socks.

Vigil showed a graphic representing patient flow. "Patient flow contributes to safety and satisfaction. We have developed process improvements for moving patients from one department to another. It helps us improve overall health care."

She noted that the staff had identified peak times for the ER and had added staff at those times. "For inpatient discharge, we are trying to have them occur between 11 a.m. and noon. It's a team effort."

Ponce said the hospital wanted a certain percentage on the survey. "I hope they are taken seriously, and I hope we get reports." He was assured they would receive reports.

Billings said he was a patient a couple of days prior to the meeting. "The discharge was quick. We noticed a difference."

Banks presented the CFO report and noted that because the December meeting was early in the month, the November financial report was not yet ready. "As we look at volumes, the volatility is starting to come out of the trends. As patients and discharges stabilize, we need to be rigorous about our financial management. The team at Gila Regional is working hard and it shows in the numbers. I projected the net accounts payable, the current ratio and the average payment period. I would like to focus on cash on hand and why the hospital focuses on it as much as we do. We don't make much on our cash in the bank. So why hold it? The risk around health care and especially the hospital industry, you'll see a lot of hospitals in the red. Sixty percent of the hospitals in America are expected to be in the red. We hope not to be one. That's why we keep cash on hand. There are extreme highs and lows, grant money is well and good, but a major piece of equipment can go down, or a service line be impacted by physician availability, so keeping cash on hand is a strategic imperative for all hospitals. One of our goals is to make sure the number goes up."

With no questions, Edwards presented the chief of staff report in Dr. Brian Robinson's absence. She noted the General Medical Staff had elected new officers, with Dr. Gregory Koury as chief of staff, Dr. Coliclia Meyerowitz as vice chief of staff, and Dr. Norman Ratliff as secretary. They also proposed and approved revised bylaws and regulations. This was Dr. Robinson's last meeting and report as chief of staff. Board members approved the election and the bylaws and regulations changes.

Brickner gave the CEO report. "I want to thank Dr. Robinson for his tenure as chief of staff. He has done a great job."

On the Cancer Center, "yes, we are open. With the arrival of the medical oncologist this week, we are providing all of the same services as we were a year ago. Ron Green has done a lot of hard work to get everything up and running. The medical oncologist is a locums tenens, so we need to convince him into making it a permanent position for him."

Brickner noted an educational video on the ER had been posted to the hospital's Facebook page. "This is the third installment in our video series. For December, we are shooting a video on the cancer center. The videos are also on our website [grmc.org]."

On the survey of patient experience, "we need your feedback. We are listening and we are committed to getting better."

He said the Joint Commission survey was happening that week. "We also want to see where we can improve. Because of the swing bed program, we can accelerate our Joint Commission survey making sure that we are always ready for the Joint Commission to come in."

Brickner said the third survey was a provider survey. "When we get the results, we will share them and put them out publicly. 37 percent of our physicians had not done the survey before. The results come straight from our survey provider Press Ganey. We do not know who took the survey. They are all confidential. We learned that our physicians like working here, but sometimes they needs little things like tools. In resiliency, our physicians scored above the national average, which is a testament to their love of the community. The employee survey No. 4 had the 79 percent response rate, as Melanie mentioned. Last year, we were in the 1st percentile, which meant that 99 percent of the hospitals were doing better than us. This time we were in the 9th, so we are improving, but we have a long way to go. Our scores are similar to 2019, but our scores went up because others went down. All our directors will have access to this report, so they can work on improvements. The one thing that pops out is that the hospital is incredibly siloed. The employees view their immediate work group very favorably, but that doesn't transfer to the full hospital. Often there is a high affinity to the leader of 'my' group, but it doesn't transfer to the full organization. Breaking down the siloes and breaking them down to be across the hospital is a key finding. How the employees rated the effectiveness of the work group and of the leader doubled year-over-year, so that's good. We have to figure out what we're being told in the surveys and how we can address the issues. And I will share the results fairly broadly, with you and the entire organization. In summary, we did a culture of safety on physicians' and employees' surveys, needed for the Joint Commission and to help us improve. It showed a willingness of employees to pull the lever to stop safety issues before they happen."

Scott Manis gave the HealthTech report and recognized Javier "Harvey" Salas, although he was absent, as a critical member of the governing board and thanked him.

"Greg mentioned the mock survey we did, with three team members of HealthTech doing a survey of preparation activities with our team at the hospital, looking at quality, Joint Commission preparation overall, life safety in the physical building itself, a compliance review and lastly our swing bed application readiness. The reports from the HealthTech team were quite favorable and complimentary of the dramatic improvements and the cooperation of staff. It culminated in a verbal report today and will be put in written form back to the team. The CEO search continues, and we have some highly qualified candidates coming in early January. The process continues to press forward. I anticipate a permanent CEO soon."

During member reports, Billings said he was impressed with GRMC and the patient flow. "I have an appointment with a cardiologist in Albuquerque next week. Dr. Stanley and his office staff were great. The emergency room doctor found something in my heart that I've had since I was 18. Finally, Dr. Miller found the problem that I've always known was there, and I think it will be an easy fix, maybe with pills, and I'm already taking a couple and getting blood flow to my brain and I feel good. I'm excited it was found here in my small-town hospital."

Ponce had no report.

Browne said his holiday stocking was open for anything that improves blood flow to his brain.

Edwards said she was at the hospital the previous day and "HealthTech's Carolyn St. Charles made a point to tell me that when they were last here in June for the mock survey they did that the improvement in the level of work done was absolutely phenomenal. She made it a point to tell me how great our staff is and how hard everyone was working ,and she really appreciated the amount of work that had happened since last June."

Edwards noted that she should have said at the beginning of the meeting that Member Salas was in Phoenix having a specialized test, which was similar to a CT scan.

The meeting adjourned.