Hospitals serving both large and small populations face a number of challenges. Regardless of size, they all face the same regulatory demands. Federal, state and local agencies impose a number of requirements on all healthcare facilities. While attracting a sufficient number of board certified physicians is a challenge in all cities and towns, it is even more so in smaller communities.
Resort communities, like Highlands, face the additional problems of seasonal population swings. The hospital serves nearly 30,000 people during the spring and summer months. Most of those live in southern Macon and Jackson counties, with a few in the service area that stretches into neighboring Transylvania County and upper Rabun County across the state line into Georgia. The demographic picture changes substantially in the winter off season, dropping to between 8,000 and 9,000 residents.
Add to those numbers an aging population, and the problem becomes clear. While those over 65 years old represent 12 percent of North Carolina’s population, a 2009 Highlands Parks & Recreation Department study showed that the over 65 group amounted to 36 percent of Highlands’ population. Another 29 percent of the plateau’s population is between 55 and 65.
Today, the Highlands-Cashiers Hospital (HCH) occupies a wellequipped facility on Highway 64-East, approximately halfway between Highlands and Cashiers. Its medical staff of highly experienced physicians represents medical specialties covering 14 areas of healthcare — specialties usually only found in much larger facilities. Emergency care is 24/7 and offers a unique guarantee: no waiting. HCH also provides physician clinics, a long-term care facility, skilled rehabilitation and medically-based wellness programs, allowing individuals and families nearby access to professional care in these critical areas.
Like all other healthcare facilities in this country, HCH has experienced the effects of the economic downturn. And like many other hospitals in the U.S., HCH has both an operations board and a foundation. Unlike the others, however, HCH depends on its foundation for a large portion of its operations budget as well as for capital improvements and equipment.
In June of this past year, HCH employed a new Chief Executive Officer, Craig James. In just six months, James has instilled renewed confidence with the Highlands and Cashiers communities concerning the long-term stability of HCH. He has instituted cost reductions without any reduction in the provision of healthcare. He has also made customer service a top priority at HCH, even though that’s a phrase rarely heard among other healthcare facilities.
“I’ve spent considerable time during my first few months here, bench-marking with similar size hospitals,” said James. “We’ve focused on assessment of other ways to do things ... to improve operating efficiencies.”
Another major initiative implemented in October was what James refers to as “flex staffing.” He says, “We operate in a seasonal market. The flex staffing plan matches staffing levels with productivity requirement levels. From November to May, the population is less than half of what it is in the summer. We’ve been able to reduce our staff during that time to meet our needs through increased vacations and time off for our FTEs (full-time employees). We’ve also been able to develop a pool of people who don’t want to work full-time to fill in when unplanned events occur.”
James’ responsibilities not only include the 24-bed, acute-care facility, but also include the 84-bed Fidelia Eckerd Living Center as well. Since the center is attached to HCH, residents are only seconds away from 24/7 medical resources.
James is well aware that community support is the life blood of HCH. Here’s what Earle Mauldin, chairman of the HCH Foundation Board of Trustees, says about James: “Since his arrival in June, Craig James has quickly gained the respect and confidence of the (HCH) Foundation Board of Trustees. He brings a great deal of experience in dealing with the challenges of small rural hospitals and will lead our hospital through a somewhat uncertain future for healthcare in our region. The continued generosity of our donors will be critical in the years ahead, and Craig has shown great sensitivity to our donors’ expectations that we can provide great healthcare while being effective stewards of our assets,” said Mauldin.
“He has undertaken a number of initiatives to improve operating efficiency and has played an active role in demonstrating to the community that our hospital is the most critical civic asset on the Highlands- Cashiers plateau.”
Robin Taylor, HCH executive director of Foundation and Marketing, adds, “Since Craig arrived last June, I have noticed a sense of increasing optimism about our hospital from our donors and the surrounding communities, and this means everything to the hospital’s success. The public’s positive outlook toward our hospital is critical to sustaining optimal utilization as well as to achieving successful charitable funding.”
Charitable gifts to the HCH Foundation are integral to the hospital’s budget and business plan. In 2011, the Foundation budget is to be aligned with the hospital’s budget to provide $1.6 million for programs, services and capital needs. Over the long term, the Foundation aspires to raise $20 million in five years: $2 million per year for services, support and capital needs and $2 million per year to grow the endowment fund for the hospital’s future financial stability. Last year, contributions totaled about $1.8 million with $900,000 in new pledges.
You can’t talk with James without his invoking “customer service.” He believes it is critical to the successful operation of the hospital. He says it has to begin in the emergency room. That’s why the “no waiting” guarantee. James says, “The emergency room is really the front door of the hospital. While most people that are admitted to the hospital come because the doctor has sent them, people choose to go to the emergency room. They could choose to go somewhere else.”
Should patients at the HCH emergency room be diagnosed with problems that need attention elsewhere, they can be transferred by air ambulance to Mission Hospital in Asheville for direct admission in 10 minutes, less time than it takes to be admitted from the Mission Hospital emergency room. “We have a protocol that provides for direct admission from this hospital,” James says.
Many patients take the time to write letters about the care received at HCH. Frequently they mention that the nursing care is especially compassionate and that the physicians take the time to “really know” patients and carefully explain their medial situations.
James was only on his second day on the job at HCH when he conducted his first “Grand Rounds Tour.” That began a monthly basis program as a community outreach initiative to learn about the hospital. Open to the public by pre-registration, participants began at 7:30 a..m. by having breakfast with the doctors and James. The program provided ample time for interactive dialogue with doctors and hospital leaders, followed by a behind-thescenes tour of the hospital. Participants learned what was involved in patient care from the perspective of relaxed discussion and an insightful tour rather than from the perspective of when they became patients preoccupied with their own illnesses.
The tours are scheduled monthly throughout the summer season. This year the first such tour will be June 15. During the off season, HCH will schedule tours upon request. Call (828)526-1435 for additional information.
HCH has 14 full-time active physicians on staff plus 22 consulting and associate physicians. Diagnostic services include MRI, CT scanning, EKGs, digital mammography, ultrasound technology, conventional radiology and fluoroscopy, stress testing, nuclear medicine and a complete range of laboratory procedures. HCH is one of 68 hospitals in North Carolina who meet the required standards of care to qualify for the standardized RACE program (Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments).
Surgery and specialty services include: Anesthesiology; Endoscopy Center; Family and Internal Medicine; General surgery; Ophthalmology; Orthopedic services; Plastic surgery; Gynecology and Women’s services and Hand surgery.
As for the future, you can expect changes. James says that he anticipates considerable change as a result of the Healthcare Reform Act. First he expects a tremendous increase in outpatient services along with an increased demand for primary care. He also thinks there will be a shortage of primary care physicians, in part because more and more doctors are entering other specialties and in part because of the increased demand. As a result, an increase will occur in the use of mid-level healthcare, i.e., more Physician’s Assistants and Nurse Practitioners. As the number of what James calls “self-insured” (people with no insurance) declines as result of the Healthcare Bill, the demand for doctors will obviously increase. Bundling will become a standard practice, that is, receiving one bill that includes all hospital charges, physician charges as well as laboratory and testing charges.
James and his wife, Sheryl, came to Highlands from Norton, Va., where he was the CEO in charge of two hospitals within the Mountain States Health Alliance Hospital system: Norton Community Hospital, a 110-bed facility and Dickenson Community Hospital, a critical access hospital in Clintwood, Va. Prior to that, his experience included CEO of Person Memorial Hospital, an affiliate of Duke University Health System in Roxboro, N.C., and president and CEO of Tazewell Community Hospital (Carilon Health System) in Tazewell, Va. He was vice president of operations at Caldwell Memorial Hospital in Lenoir, N.C., and has worked in hospital management positions since 1983. A native of Winston-Salem, James holds a B.S. in Business Administration from Appalachian State University and a Masters Degree in Public Health Policy and Administration from the University of North Carolina at Chapel Hill.
Charles Sheehan, chairman of the Hospital Board, says, “I am extremely enthusiastic about the thoughtful, yet forceful leadership Craig James has brought to HCH. He understands that our first priority in providing outstanding healthcare to the community is to maintain a superb cadre of board certified physicians. He is actively engaged in implementing physician contracts that reward and motivate our physicians. He also understands that to be financially viable in a highly seasonal market, hospitals must better match resources (cost) with volume ... Hospitals in the U.S. are faced with enormous uncertainty due to the muddied prospects for healthcare reform. Craig’s great understanding of rural hospital dynamics place him in a far better position than most to navigate HCH through these uncharted waters.”