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HGH Board Brief April 30, 2019

Trustees present: JoAnn Casalez, Chairman; Bill Hammargren, Jennifer Hood and Gene Hunt. Trustees not present: Michelle Miller, Secretary, and Ken Tipton.

Medical Staff-Hospital Department Reports

Medical Staff Report

Dr. Paul Gaulin is Humboldt General Hospital's new Chief of Staff

Dr. Paul Gaulin, Humboldt General Hospital's new Chief of Staff, reported on the medical staff and said members continue to move forward in their various responsibilities.

Hospital Week Report

EMS Director Sean Burke reported on Humboldt General Hospital's preparations for Hospital Week 2019, which will be held from Monday, May 13, through Saturday, May 19. Scheduled events for both staff and the community include:

  • Monday, May 13: Administration Open House
  • Tuesday, May 14: Community Cleanup Event
  • Wednesday, May 15: Health Services Lunch and Learn
  • Thursday, May 16: Chamber of Commerce Mixer/Provider Meet and Greet
  • Friday, May 17: Employee Recognition Dinner
  • Saturday, May 18: EMS BBQ and Bike Rodeo

Sean invited board members to participate in the events that fit within their schedule during the week, especially Friday's Employee Recognition Dinner where three groups will be feted: "Years of Service" recipients; "Nightingale Nurse of the Year" nominees and winner; and, "Nurse Resident" graduates.

Clinic Space Utilization

HGH Practice Administrator Robert Johnson, PA, reported on clinic changes that will be forthcoming following an in-depth look into patient needs, clinic efficiencies, and available space.

Robert noted that the objectives of the clinic space utilization study was to:

  • Enhance the overall patient experience
  • Cluster similar services in key areas
  • Reduce patient travel throughout the facility
  • "Expand" the use of space within the same physical footprint
  • Maximize efficient use of space
  • Create a flexible plan that can evolve with future changes

Among the proposed clinic changes, Robert said Suite A, the medical office suite located closest to the main admit desk, as well as ancillary services such as Laboratory and Radiology, will be designated for Internal Medicine providers and their traditionally older patients who may have decreased mobility. The HGH Orthopedic Clinic (Suite B) and the HGH Walk-In Clinic (Suite C) will remain in their current locations on the ground floor of the medical office building.

On the second floor of the HGH Medical Office Building, the HGH Surgery Clinic (Suite F) will remain in its current location. Suite E will continue to house the hospital's part-time providers; currently Dr. William Beckman sees gynecology patients part-time there. Suite F will be designated as a Family Practice suite for a future provider. Echo Mathews, FNP, will move into Suite G on May 13; and Suite H may house Dr. Alex Curtis, a Family Practice/OB physician, who is hoping to join the HGH medical staff in June pending approval of his medical licensure by the State of Nevada. However, Robert also said that Dr. Curtis may practice in the Rural Health Clinic, where administrators hope to create designated spaces for women and children.

Robert further said the Rural Health Clinic will now house a Women's and Maternal Health Clinic, where Dr. Roger Brecheen, Dr. Sara Thorp, and two proposed nurse midwives will see patients. A Pediatric Clinic also will be housed in the Rural Health Clinic for Veronica Janhunen, MD, who will begin practicing at HGH in August. The HGH Rural Residency Clinic will continue in its current location, also in the Rural Health Clinic.

Long-Term Care Update

HGH Chief Nursing Office Darlene Bryan updated board trustees on long-term care. She said she and Harmony Manor/Quail Corner Director Robin Gillis have met with Board Trustee Michelle Miller twice as part of a monthly meeting. An action plan, which includes updating the intake packet that residents and their families receive, was implemented. Darlene said the goal is to have a complete intake packet submitted before a resident will be considered for admission. Robin Gillis will be the central point of contact for all questions regarding long-term care admissions. Robin's business cards are now located at the Acute nurse's station; if Robin is unavailable, her calls will be forwarded to HGH Social Worker Jennifer Slovernick. Darlene said the committee also discussed instituting a quarterly improvement study to see what they can continue to improve in the long-term care enrollment process. She said one of the group's immediate goals is to get back with people in a more timely fashion and schedule appointments with those who have questions.

Darlene also discussed the hospital's recruitment efforts with regard to certified nursing assistants (CNAs). The lack of CNAs diminishes the hospital's ability to place more residents in long-term care; currently, Harmony Manor and Quail Corner are down seven CNAs. Humboldt General Hospital is working with Great Basin College to train CNAs. HGH is sponsoring two students, who will come to work at the facility following their certification in May. In all, Darlene said the hospital is hoping to hire five aides from the current class. Darlene also said that HGH has learned it can hire nursing aide trainees after two weeks of CNA education; the students will still finish their CNA course, but will begin working at the hospital, performing very basic aide functions right away. Robin Gillis is working on a job description. Currently, 35 of 42 beds in long-term care are filled, leaving seven vacancies. Darlene said by filling the CNA posts, long-term care can admit seven more residents. She also said long-term care now has adequate nursing staff.

Darlene said the long-term care committee is also working on resolving Medicaid issues through a weekly admissions committee meeting.

Administration Department Report: CEO

HGH Interim CEO Karen Cole introduced Rick Roche to board trustees. Rick is the new interim Human Resources Director at HGH following the retirement of Rose Green earlier this month. Rick has over 20 years experience as a Chief Human Resource Officer; he also has extensive experience as an administrative supervisor to other hospital departments. According to CEO Cole, Rick's immediate priorities are to become oriented to HGH's staff and systems; fill recruitment needs; and, explore implementing the HRIS Optimum system. HRIS Optimum Optimum is an industry-leading, full-service software designed specifically for Human Resource needs. The system was slated to come online next year, but CEO Cole and Rick are hoping to move that date up to this year to deal with immediate priorities.

CEO Cole also updated the board on physician recruitment efforts.

  • Veronica Janhunen, MD. Veronica Janhunen, MD, a board-certified Pediatrician, will join the HGH staff in August 2019. She is looking for a home and is excited to be returning to her hometown.
  • David Masuck, MD. David Masuck, one of HGH's Rural Family Medicine Residency physicians, has been given a proposed agreement to join the HGH staff as a Family Practice doctor in August 2020, following his graduation from his rural residency specialty.
  • Rommel Adajar, MD. Rommel Adajar is an Internal Medicine specialist who is interested in practicing in Winnemucca. He is currently working in Iowa; however, his family and home are in Reno, Nevada. He is scheduled to come for a site visit on May 16.
  • Dr. Sandhu. Dr. Sandhu is a Family Practice physician who is currently finishing a rotation in Obstetrics. CEO Cole is working to connect with her to see if she is interested in coming to HGH for a site visit.
  • Alex Curtis, MD. Alex Curtis, MD, has signed an agreement with the hospital to provide Family Practice/OB services; his medical license application for Nevada is slated for consideration in June.

CEO Cole discussed an upcoming meeting on May 10 with Dr. Andrew Wesley, a Pain Management specialist. CEO Cole said Dr. Wesley would like to meet with medical staff to better understand their needs.

CEO Cole discussed a May 3 meeting with Dr. Freeman of Sleep Medicine Associates where he will discuss the results of a feasibility study to determine if sleep studies can begin taking place at HGH.

CEO Cole said the hospital continues to evaluate options with regard to Telepsychiatry.

CEO Cole updated board trustees on the Cerner electronic health record conversion process. The next training--Workflow and Integration--will take place May 21-23. Between 25 and 30 members of the Cerner team will be on site to discuss current and future workflows along with integration into departments. Discussions will also center on recommended best practices for future processes. Currently, CEO Cole said departments are gathering data and files to begin building the system. Departments are participating in weekly calls with project management teams, and the multiview financial system is scheduled to go live in September 2019.

CEO Cole shared upcoming board meeting dates, including a Board/Medical Staff Mini-Retreat scheduled for 5:30 p.m. Friday, May 10, and 9 a.m. Saturday, May 11. Phil Zarone will facilitate those meetings.

Additionally, CEO Cole shared information with trustees regarding the 23rd Annual Western Regional Trustee Symposium June 5-7 in Missoula, Montana.

Financial Reports

HGH Interim CEO Karen Cole shared highlights from the March financial statements.

Patient days were over budget month-to-date by 9.2%, although year-to-date numbers remain under budget by 6.5%. Surgical cases, however, were over budget both for the month by 33.9% and for the year by 12.1%. Emergency Room visits were over budget month-to-date by 0.3% and year-to-date by 1.8%. Rural Health Clinic visits were also over budget month-to-date by 18.7% and year-to-date by 3.7%. The hospital continues to struggle with clinic visits due to a lack of providers. For the month, Rural Health Clinic visits were down 17% for the month, and 17.8% for the year.

CEO Cole said operating income for the month saw a positive variance of 191.2%; for the year, the hospital is still operating in the negative, but still saw a positive variance. Net income for the month was $704,060 against a budget of $76,638. For the year, net income is $3.1 million against a budget of $746,684, for a positive variance of 818.7%.

Consent Agenda

The board approved the Consent Agenda, including the board meeting minutes for March 26, 2019; March 30, 2019; and April 9, 2019. The board also approved medical staff appointments, reappointments, provisional and temporary privileges for 10 care providers.

Business Items-Other Reports

1. Hospital Administration-EMS / proposal to procure security services for hospital, outbuildings and grounds / EMS Director - EMS Chief Sean Burke presented a request for security guard services at the hospital. Sean said HGH has a large campus with various points of entry. Unfortunately, national trends indicate that workplace violence, especially in the healthcare setting, is on the rise. Last year, HGH had 399 calls for service with the Winnemucca Police Department, including multiple unauthorized intrusions inside the HGH facility. In one instance, a local provider was threatened with a firearm in his office. Under Sean's direction, the HGH Security Work Group developed several potential options to employ armed security guards. Allied Universal, the company that has been providing contract security services at HGH since January, was the only vendor to provide a quote for around-the-clock security guard services. The HGH Security Work Group also looked into HGH hiring its own guards, but the cost for 6 full-time staff equivalents, plus benefits, training and liability insurance, was prohibitive. Sean recommended the board choose Allied Universal to provide security guard services. Board Chairman JoAnn Casalez said she has been supportive of security services at the hospital since she came on the board. She said Sean's presentation provided good information and answered her questions. She also appreciated staff sharing how much safer they feel with a security presence at the hospital. Trustee Bill Hammargren said he would like to see quarterly data moving forward, especially regarding how many calls to the Winnemucca Police Department now originate from the hospital as compared to pre-security times. He said he would also like to see staff surveyed after six months regarding the security services. Trustee Gene Hunt said he would like reports to differentiate between calls that occur after action by a security guard versus calls without security's involvement. Sean said he believes there will be a dramatic dip in the number of calls to the police department. The motion to contract with Allied Universal for one year at a cost of $302,000 passed unanimously.

2. Hospital Administration-OR/ proposal to purchase scopes for operating room /OR Director - HGH Operating Room Director Janet Sturtz requested two new scopes for the OR: a colonoscope that allows direct visual examination of the large intestine and rectum, and a gastroscope that allow direct visual examination of the inside of the upper gastrointestinal tract (esophagus, stomach and duodenum). Janet said the gatroscope is a slimmer design, which can be used on pediatric patients. Both offer brighter, more powerful imaging, providing twice the viewable distance as compared to earlier scope models. Janet had budgeted $120,000 for the new equipment, but was able to take advantage of several offers through her sales rep. Trustees unanimously approved the two new scopes and a processor for a total price of $87,595.25.

3. Hospital Administration-Pharmacy/ bids-proposals for pharmacy-physical therapy remodel project / award of contract for pharmacy-physical therapy remodel project / Owners Rep-CTA - HGH Owners Representative Mike Sheppard presented the sole bid from Sletten Construction of $2.795 million for the Pharmacy-Physical Therapy remodel. Approximately $1.5 million was budgeted for the project. Part of the extra cost results from a $900,000 HVAC project, which trustees agreed should be completed while construction crews are on site. Because the numbers were higher than expected, Mike said there are three options: reject the bid; award the bid and then immediately begin the change order process in an attempt to bring costs down; or, table the item and do a comprehensive review to determine if there are areas for potential cost savings, which includes having Pharmacy Director Dave Simsek review the project and explain why each of the various components are needed. Board trustees agreed to table this item until the May board meeting and ask Dave Simsek to review the project.

4. Hospital Administration-Clinic/ terms and conditions of employment agreement with C. Robert Westling, M.D. / Administration - HGH Legal Counsel Kent Maher advised that negotiations between the hospital district and Dr. Robert Westling continue and there is no contract yet to approve. He directed trustees to authorize staff to sign the contract, once it is complete, and bring it to the board at the May meeting for their ratification. The motion passed unanimously.

5. Hospital Administration/ request for approval of QAPI Plan policy / Administration-Quality Control - Quality Services Director Lisa Andre requested approval of a Quality Assurance and Performance Improvement (QAPI) Plan policy. Lisa said a QAPI plan is a data driven and proactive approach to quality improvement. All members of an organization, including residents, are involved in continuously identifying opportunities for improvement.

Trustee Comments

Trustee Bill Hammargren responded to Dr. Brad Granath who, during public comment at the beginning of the meeting, thanked the board for his 14 years at HGH as a private practice physician and said his goodbyes before he moves to Washington State to take a position there. Trustee Hammargren said he was lucky to be a board member when Dr. Granath and his wife, Robin, chose to come to Winnemucca. He said Dr. Granath will be missed as he plans to leave the community by June 1.

Trustee Jennifer Hood "seconded" that Dr. Granath has done an "amazing job as a doctor and a community member."

Board Chairman JoAnn Casalez also thanked Dr. Granath. Further, she thanked HGH staff for all they have done to bring about positive change at the hospital.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next for a Board/Medical Staff Mini-Retreat, scheduled for 5:30 p.m. Friday, May 10, and 9 a.m. Saturday, May 11. Phil Zarone will facilitate those meetings.

Meeting agendas, board minutes and more will be/are available at:

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