I’ve spent over three decades engaged in almost every conceivable aspect of healthcare. Since the late 1980s, I’ve been involved in the business, finance, recruitment and general operations of hospitals all around the United States. I’m no stranger to waxed floors and white lab coats. I know from firsthand experience that having a local clinic or hospital extends far beyond having medical services within reach. A hospital is a foundational institution that marks the growth, stability, and vitality of a community. The presence of a medical facility means an established community placing a strong value on health and wellness. My experiences do give me an interesting perspective on the value of rural healthcare.
In my career, I’ve had the opportunity to open or expand exceptional facilities that would go on to be public fixtures for better living, but I’ve closed facilities as well. I want to share some personal experiences regarding opening and closing, hoping they will reinforce the value of rural healthcare, especially in smaller communities.
Opening and maintaining
In 1990, I assisted in reestablishing a community hospital in Nevada that was on the verge of closing down. Almost immediately, I could see this facility’s value for the surrounding community. Luckily, the management company I worked for at the time helped the community set up a new not-for-profit corporation. A board was organized, and we negotiated separation from the regional health care system that was planning to close the facility. We helped secure financing for operating capital and recruited new leadership to officially reopen the facility.
Today they are a thriving small community health system much like Tri-County Health Care. The takeaway from this situation is that avenues do exist to maintain a healthcare system. Opening a new facility is tough, but so is closing one. A community rallying together to maintain a hospital is necessary, so my advice is to foster deep relationships with the community. Remember that we serve our neighbors, friends and families. We all have the same goal in the end.
Closing down
A year after the Nevada facility noted earlier, I shifted my focus to another small community. Unfortunately, I wasn’t called upon to reorganize and reopen but to close a small community-owned hospital in North Dakota. We spent approximately three months in our analysis and managing the facility to help stabilize the situation. Unfortunately, our analysis did not prove to offer much of a solution; it was the beginning of the end. We couldn’t do much due to a challenging rural health financial environment and receiving the call several months too late.
Shutting down a hospital or clinic is a very methodical and tiring process because a hospital is ingrained in every aspect of the community. The amount of financial and legal hurdles that need clearing in even a small facility can be staggering. The process included a review of staffing, financial considerations, market considerations and community perception issues. Considering all of this, circumstances dictated the decisions, not by anyone’s expectations or resolve to make it better. We guided the shutdown process along with a bankruptcy attorney and trustee. We would finish one project, only to reveal ten more. Informing the community and organizing transition plans proved to be the most gut-wrenching.
Aftermath
Impact on the community was, of course, difficult. The loss of services meant that most community members had to travel 15 miles or more to receive care. The local economy also suffered; the hospital had provided over 70 jobs. When you close down an organization like this, you not only lose jobs, but also the commerce invested in the community. Such a closure also brings unforeseen circumstances like the local nursing home having to find another medical partner for various services like lab work.
This isn’t discussed in board rooms or bank offices, but the loss of community pride is inherently noticeable. It isn’t like a coffee shop or hotel shutting down; you can’t just start a new hospital down the street. If a community can’t even protect its own well-being, are they a community at all? Something to think about.
The new building
Another aspect I have much experience with is the construction of new facilities. The key steps to successful projects are identifying the needs, evaluating various options, performing financial feasibility studies, and planning the project with input from the individuals closest to the work. Engaging a solid team of planners, architects, engineers, and contractors is important to bring about a new vision. I don’t know everything, and I know when it’s time to lean on others.
I want to touch on something that doesn’t often get brought up, which is moving day. Setting up a new hospital isn’t as simple as cutting a ribbon and ushering staff and patients through the door. Setting up a proper, efficient hospital requires working with internal leaders and external advisors to orient the new space. This step is critical to ensure a smooth transition. Methodical move-in practices combined with specialized training should be paramount before operations start or resume. The worst thing is having a beautiful new hospital, but it’s filled with staff who can’t find the supplies and equipment they need. A well-organized and choreographed move-in is first and foremost about patient safety.
Current status
The first portion of construction on our new building just drew to a close. The walls went up relatively quickly, and we now have a fully enclosed structure. Seeing its development step by step has been a beautifully enlightening process. New buildings are great, but the new building is only as good as the staff you put in it. I’m fortunate to have a wonderful group of professionals working with me at all times. The staff combined with this new facility will bring a new era of wellness to the City of Wadena and, in many ways, the entire central part of the state.
Thank you for reading and please try to remember the value of rural healthcare.
About Joel
Joel received his Bachelor in Business Administration degree from the University of North Dakota in 1986, and his Master of Health Care Administration degree from the University of Minnesota in 2010. He is also a Certified Public Accountant. He has been in the health care management field since 1986. Joel has been a part of the Tri-County Health Care family since 1998. Joel is passionate about conveying the value of rural healthcare while giving back to the community.
