Session and Event Descriptions

WORKSHOP #1
How Does Your Board Stack Up? The State of Governance with Insights from the 2011 American Hospital Association Governance Survey
John R. Combes, MD, President and COO, Center for Healthcare Governance, and Senior Vice President, American Hospital Association, Chicago, IL and Barry S. Bader, Bader and Associates, Scottsdale, AZ

The Center for Healthcare Governance and the Health Research and Educational Trust, with the support of the American Hospital Association and Health Forum, have analyzed the results of the 2011 AHA Governance Survey.  The survey, which was sent to all community hospital CEOs and Board Chairs, represents over 1,500 respondents.  Participate in this workshop to learn how your board and governance practices compare to those of your peers in such critical areas as board member selection, assessment, competencies, and culture, and discuss the implications of the data for board performance in the emerging post-reform environment. Bring your toughest governance issues for discussion and deliberation. This session will be very interactive, so come prepared to talk, to question assumptions and be challenged.

WORKSHOP #2
Using Strategy, Networks and Metrics for Improved Performance in Rural Hospitals
Scott W. Goodspeed, DHA, FACHE, Principal and Vice President, iVantage Health Analytics™ | Formerly Performance Management Institute, Portland, ME

Rural hospitals can improve their sustainability by becoming more strategy focused, creating robust networks of rural hospitals, and intelligently using metrics to grow and create alignment throughout the organization. Dr. Goodspeed will share the research surrounding high performing rural hospitals and networks, offering innovative approaches to compete and operate successfully.  Participants will:

• Learn how to design a rural hospital strategy in 45-60 days through a four-step process, including the board retreat.
• Understand how rural hospital strategy has evolved and receive a tool for implementing the five steps high performing rural hospitals use to become strategy focused.
• Learn how to create networks with other rural hospitals to offer greater value to patients. Understand how to measure their performance.
• Gain insights into the three cultural styles found in rural hospitals and the impact of the most effective leaders.

Each participant will receive a strategy template, a rural hospital board retreat agenda, a strategy execution workshop agenda and rural relevant metrics from four perspectives. Participants will also receive an abbreviated market assessment as well as their hospital's quartile performance related to the Hospital Strength Index™: an analysis of their hospital's market strength, value-based strength and financial strength.

CONFERENCE WELCOME & INTRODUCTIONS
Presentation of the 2011 AHA Section for Small or Rural Hospitals Shirley Ann Munroe Leadership Award

GENERAL SESSION
A Call to Action: Patient Experience as a Top Strategic Priority
M. Bridget Duffy, MD, Chief Executive Officer, ExperiaHealth, San Francisco, CA

Too often, health care leaders focus on efficiency and financial performance without regard to the impact on patient experience.  But, with the implementation of CMS-mandated patient satisfaction surveys, public reporting, and pay for performance, patient experience has become a growing priority.  More importantly patient experience can and should be the rallying point for building successful health care organizations. Join Dr. Bridget Duffy in her examination of why, during this turbulent time in health care, organizations should focus on creating a culture of caring and competence.  Dr. Duffy will address why it is important to align health care organizations around patient experience from the Board to the front line, and why physician engagement and leadership of this strategy is essential to success. Dr. Duffy will draw on her experience as the first Chief Experience Officer of Cleveland Clinic and working with health care systems across the country to explore the connection between quality, safety, and patient and employee experience.

GENERAL SESSION
The Governance Challenge: Jumping the Curve to Deliver Value
James E. Orlikoff, President, Orlikoff & Associates, Inc., and Senior Consultant, Center for Healthcare Governance, Chicago, IL

Hospitals face immediate financial stress due to the imminent impact of reduced reimbursement rates and the overall economy. Yet they also face the critical reform challenge to create different organizations that truly deliver value.  This is the classic "two curve problem": boards must assure that their hospitals perform better under the first curve while they prepare to force them to jump to the second.  This presentation will address this great governance challenge and outline the issues involved and strategies to successfully jump the curve.

STRATEGY SESSIONS

#1 High Reliability in a Rural Setting: Using the Blueprint of High Reliability Organizations to Improve Patient Safety and Quality
Charlotte Burns, CEO, Hardin Medical Center, Savannah, TN and Capt. Steve Harden, Chairman and CEO, LifeWings Partners LLC, Memphis, TN

After a catastrophic loss of thrust in both engines, US Airways flight 1549 under the command of Capt. "Sully" Sullenberger landed in the Hudson River in New York City. Capt. Sully and his crew have been widely hailed as heroes in the "Miracle on the Hudson." The culture of safety that contributed to the successful outcome of this near-tragedy is created through essential leadership actions combined with three key ingredients seen most often in High Reliability Organizations. In this session, we will analyze the lessons learned as they relate to rural health care leaders and organizations. With a mix of compelling stories and interactive exercises, participants will understand how Hardin Medical Center followed the blueprint of High Reliability Organizations and engaged in a five-month patient safety project in the areas of surgical services, ED, and medication reconciliation to improve culture and care for their patients. You'll learn about the project methodology which included training workshops for leader development, organizational structure, data collection, site assessments, CRM-based teamwork skills training, physician alignment, and safety tools creation and implementation.

#2 From Competition to Collaboration:  A New Vision for Rural Health Networks
Jeff Ellis and Martie Ross, Principals, Spencer Healthcare Strategists, Kansas City, MO

With the intense focus on quality reporting, value-based purchasing, and bundled payments, rural hospitals and physicians are challenged to build strategic alliances to leverage limited resources.  Rural providers who have long focused solely on their own communities and viewed providers in neighboring towns as competitors now should seize the opportunity to opportunity to form collaborative care organizations.  These next generation rural health networks hold the promise of overcoming years of distrust by providing a formal process for strategizing and implementing new models to improve health care quality and health outcomes on a regional basis.  This session will focus on first-step opportunities for collaboration around development and implementation of rural-specific clinical protocols and quality measures.

#3 The Challenges of Governing Executive Pay
Kevin Talbot, EVP & Practice Leader, Integrated Healthcare Strategies, Minneapolis, MN and Susan O’Hare, SVP, Integrated Healthcare Strategies, Minneapolis, MN

Governing executive pay at rural hospitals poses unique challenges. Often the highest paid individuals within a rural community, their pay can become a lightning rod for public debate and criticism. It is crucial that the organization have a strong governance infrastructure to prevent compensation from distracting from the execution of the organization’s mission. Boards must utilize best practices in the governance of their executive pay in order to comply with current legislative regulations including developing an independent executive compensation committee and compensation philosophy that proscribes the process for review, and defining a peer group using national data instead of State Hospital Association comparability data, to asses market competitiveness. This presentation will explore these and other strategies that rural Boards can use to prepare a multi-faceted communication strategy that transcends a single event-oriented response.

#4Community-Based Recruiting and Why It Works
Sharon Vail, Executive Director, Rimrock Health Alliance, Prineville, OR

Rural communities face a primary care physician shortage, and many find it increasingly difficult to recruit, and retain, physicians and other health care professionals. Prineville, Oregon is the exception having recruited a psychologist, general surgeon, three family practice physicians, and two physician's assistants in just over one year. Rimrock Health Alliance, a unique nonprofit organization, provides a way for Prineville health care providers and the community to become partners in the recruiting process. Rimrock's recruiting model emphasizes economic development as a vehicle to demonstrate to city and county governments that attracting quality health care providers isn't just about intangible good feelings. Learn why this approach helps fulfill the "Triple Aim," hear about successful real-life recruiting efforts, and understand why hospital leadership must take a role in building partnerships with local physicians, and include them in recruiting … even if they're the competition.

Networking Lunch with Hot Topic Roundtable Discussions
Grab lunch and join a roundtable discussion group for facilitated conversation on critical issues and topics in rural health care. Share what's working well in your organization and gain advice on what you're struggling with. Take advantage of this opportunity to tap into your peers' expertise.

GENERAL SESSION
The Unfolding Impact of Health Care Reform on Rural Providers
Tom Morris, Executive Secretary, National Advisory Committee on Rural Health and Human Services, Director of the Federal Office of Rural Health Policy, Rockville, MD; A. Clinton MacKinney, MD, MS, Assistant Professor, RUPRI Center for Rural Health Policy Analysis, University of Iowa, College of Public Health, Iowa City, IA; and Keith J. Mueller, PhD, Gerhard Hartman Professor and Head, Department of Health Management and Policy, College of Public Health, University of Iowa and Director, Rural Policy Research Institute, Center for Rural Health Policy Analysis, Iowa City, IA

As health care reform continues to evolve and national priorities shift in the coming election year, this panel of rural health care leaders is uniquely qualified to share their perspectives on the impact of these and other changes on rural hospitals and providers. They'll address the evolution of rural delivery systems in the emerging environment and explore the need for strategic partnerships to improve and sustain access to high quality health care in rural areas. Additionally, they'll touch on trends in workforce and health information technology development. You'll learn what it will take to be truly accountable for the care of your community in the new environment and better understand how to take advantage of the resources that are available to your hospital and community.

STRATEGY SESSIONS REPEATED

NETWORKING RECEPTION
Support for the reception is generously provided by

SUNRISE SESSIONS

Delivering Patient Centered Care through Physician Alignment in a Broad Regional and Rural Service Area
Mark Shuter, President and CEO, Adena Health System, Chillicothe, OH; John Fortney, MD, Chief Medical Officer, Adena Health System, Chillicothe, OH; and  Jeff Graham, Chief Strategy Officer, Adena Health System, Chillicothe, OH

Several years ago, Adena Health System embarked on a significant effort in physician alignment and growth across a 13-county region in rural southern Ohio with the ambitious vision to become a truly patient centered organization.  These efforts have resulted in extraordinary gains in patient satisfaction and quality outcomes.   In this session, senior leaders will demonstrate how a physician integration strategy can support growth and brand development in a rural market.  They will describe the positive impact of integration on key quality initiatives and explore how affiliations can support regional growth.  You will learn what characteristics of physician leadership proved critical to the effort and understand the importance of having the right physician EMR platform. 

Blood, Sweat and Teams: The Journey of Two Critical Access Hospitals to a Patient Safety Culture
Jeffrey N. Sackrison, FACHE, President, Chowan Hospital/Bertie Memorial Hospital, Edenton, NC

By focusing on a healthy leadership team, Chowan Hospital and Bertie Memorial Hospital have made incredible strides in the development of a safety culture. From MRSA reduction to VHA Return to Care to Patient and Family Centered Care, BMH and CH have successfully implemented a host of quality and safety improvement initiatives. This presentation will describe how team-building, leadership, staff buy-in and transparency have supported the patient safety culture at the two hospitals. The presentation will make connections between long-standing quality improvement tools like PDCA cycles and other more innovative methods like daily safety huddles by reviewing systems improvement and leadership initiatives that support the advancement of the patient safety culture.

GENERAL SESSION
Influential Leadership: Change Your Behavior, Change Your Organization, Change Health Care
Michael Frisina, PhD, Elgin, SC

Leaders make things happen. Influential leaders go a step further by making a positive difference in organizations and in the lives of people who both serve and are served by the organization. Influential leaders perform at a higher level, are more productive, and achieve greater results than other leaders with similar circumstances and resources. Michael Frisina reveals how successful and effective leaders are driven by a set of behaviors that enables them to become role models for followers, guide operational improvements, and sustain excellence. He will share critical concepts to achieve organizational excellence and inspire better performance through influential leadership. You'll learn how your behaviors affect (negatively or positively) the outcome of your work, the lives of those around you, and the overall performance of your organization. Understand how the ability to become an influential leader is directly proportional to the ability to manage behavior and the way it affects others.

GENERAL SESSION
The Rural Hospital Federal Update  
Lisa Kidder Hrobsky, Vice President, Legislative Affairs, American Hospital Association, Washington, DC and Joanna Kim, Senior Associate Director, Policy, American Hospital Association, Washington, DC

Ms. Kidder Hrobsky will drill down on rural specific issues including recent Administrative and Hill activity on Critical Access Hospitals and rural PPS hospitals. Learn how the Congress and the administration will function in an election year and what it means for rural community hospitals.  Ms. Kim will discuss recent regulatory action affecting rural hospitals, including on the outpatient PPS and value-based purchasing.

STRATEGY SESSIONS

#1 Successful Implementation of the Medical Home Model in Rural Markets
Craig Holm, FACHE, Senior Vice President, Health Strategies & Solutions, Inc., Philadelphia, PA and Martin Lipsky, MD, Regional Dean, University of Illinois College of Medicine at Rockford, Rockford, IL

Health care reform is progressing with the formation of ACOs and the evolution to risk payment.  Certain markets have evolved to a greater degree than others, but one model has gained much traction:  Patient Centered Medical Home.  In this session, Dr. Lipsky and Mr. Holm will present successful approaches of Medical Home implementation, including effects on provider compensation, effects on quality and costs of care provided, and other lessons.  The focus will be on industry examples from rural markets.

#2 Do You Think You Want to Affiliate? Think Again.
Robert A. Vento, Senior Vice President, QHR, Brentwood, TN and Melissa Fraser, Board Chair, West Park Hospital, Cody, WY

A lot of noise is circulating in the market about hospitals needing to “affiliate” to survive.  The first questions your board should be asking are:  “Is our strategic plan updated and being followed? Is our hospital performing well?  Can we access capital? What does our community need that we can’t provide?”  You might be surprised at the answers. Now is the time to take stock of your hospital’s performance and your mission. Learn how to evaluate your options for maintaining independence and pursue affiliation models based on your hospital’s and community’s needs.  He will be joined by a rural hospital board chair who has successfully developed relationships to achieve hospital goals without an exchange of assets or loss of financial control.

#3 Strategies for Enhancing Collaboration between Rural Hospital and Foundation Boards
Kelly Arduino, Director, Financial Advisory Services, Wipfli LLP, Chicago, IL

Board members know all too well that rural health care has many constituencies. Not only are hospital board members responsible for working productively among themselves to provide strategic direction and oversight of the hospital itself, but also are often required to coordinate efforts with the health system foundation board. This session will discuss practical solutions and methods for working effectively across both hospital and foundation boards, including trends in board composition and governance as well as approaches to joint strategic planning and optimizing assets across the health system

#4 Telemedicine -- Frontier Leaders Grow Coverage and Coalitions
Casey Meza, CEO, Clearwater Valley and St. Mary's Hospitals and Clinics, Orofino, ID; Michael Meza, MD, Clearwater Valley Hospital and Clinics, Inc., Orofino, ID and Tiffany Whitmore, MPA, Saint Alphonsus Health System, Boise, ID

Using mobile robots, patients in frontier Idaho access remote psychiatrists, cardiologists, and dermatologists. Medical staff consult with hospitalists and ER specialists. Eight years ago, connectivity at the two hospitals was limited to dial-up internet for only 25 employees. Today Clearwater Valley and St. Mary's Hospitals and Clinics are exploring emerging technologies for improving care delivery that are accessible to rural providers. Patient needs have led the hospitals to challenge phone companies to improve connectivity, to bring urban hospitals from across the state into an alliance to improve reimbursement opportunities, and to reach across multiple state lines to find innovative partners willing to bring services to the frontier. They are developing unique partnerships and collaborations that are growing from frontier demand, rather than just reacting to urban supply. How did critical access hospitals in a poor, remote location get from there to here? What’s the business model and the recruitment case? What challenges and potentials lie ahead? This session will help you calculate telemedicine’s potential financial benefits and demonstrate how to undertake a journey toward providing cost-effective specialty care in rural and frontier settings.

Networking Lunch

STRATEGY SESSIONS # 1 - 3 REPEATED WITH NEW SESSION #4:

#4 Moving a Rural Hospital into the Information Age… Achieving the Paperless Goal
Lynn Fulton, COO, Kewanee Hospital, Kewanee, IL

The presentation will cover the adoption and implementation of information technology and the electronic health care record at Kewanee Hospital, a Critical Access Hospital in a small Illinois community. It will touch on what was needed for solid infrastructure, policies, procedures, guidelines, committee facilitation, resource allocation, and leadership commitment. The presentation will also openly discuss some of the hardships and struggles experienced during the journey, and how the organization was able to overcome them to achieve the goals. Ms. Fulton will also discuss the future goals for the organization around meaningful use and achieving recognition as among H&HN's Most Wired Small and Rural hospitals. The session will be appropriate for basic to intermediate audiences, so those hospitals just beginning their technology endeavor and those who are in the middle and struggling with EHR acceptance will find it worthwhile.

SPONSORED SESSION

Financing the Future of Independent Community Hospitals
Alan P. Richman, President & CEO, InnoVative Capital LLC, Springfield, PA, and Michael Ambrosiani, Chief Financial Officer
Knox Community Hospital, Mount Vernon, Ohio

Staying viable as an independent community hospital is not easy. Sidetracked by the economy, many hospitals face a double imperative to modernize their facilities and recruit physicians. Learn how to succeed and prosper as a stand-alone hospital by combining new revenue sources and low-interest loans in this brief presentation with Q&A.

Support for the session is generously provided by

Optional Recreational Activities
Stretch your legs with a stroll across the desert or explore the best of the Old West through art, cuisine and shopping by joining us at one of two fun activities. Registration required for both activities. Guests are welcome!

Dreamy Draw Nature Hike
3:30—6:00 pm

Old Town Excursion
3:30—6:30 pm (transportation provided)

STRATEGY SESSIONS

#1 The Next Step for Benchmarking
Darlene D. Bainbridge, CEO/President, Darlene D. Bainbridge & Associates, Inc., Cuba, NY and Sally Perkins, Director of Data Services, Kansas Hospital Association, Topeka, KS

Rural hospitals have some of the greatest needs for effective benchmarking as the growing strain on resources makes it imperative that they achieve their goals on the first try in ways that protect the performance potential of the workforce while always raising the bar on quality. Benchmarking activities must create greater value by helping rural providers to strengthen outcomes for patients and processes that deliver those outcomes. Benchmarking that reaches beyond simply collecting and comparing numbers to approaches that make it easy for providers to learn from the best practices of others has greater potential for rural providers who frequently find it difficult to access such information in other ways. During this session, the presenters will discuss what providers are looking for from future benchmarking activities that operate with the goal of creating business value while managing quality. They will demonstrate the features in a tool designed to reach beyond simple comparisons to learning best practices.

#2 Collaborating to Achieve a Lean Management Culture
David Masterson, Chief Executive Officer, Sampson Regional Medical Center, Clinton, NC; Jeff Spade, Vice President, North Carolina Hospital Association and Executive Director, North Carolina Center for Rural Health Innovation and Performance, Cary, NC; and Michael Chamberlain, President, Simpler North America, Bloomfield, IA

Competitors by nature, the 11 rural hospitals in the North Carolina Rural Hospital Lean Collaborative have worked together to share and network in order to better understand the common barriers to achieve break-through performance improvement. The most unique aspect of the North Carolina Rural Hospital Lean Collaborative is that the effort is organized and managed by rural hospitals that are innovating, transforming—and leading the way—in improving the quality and safety of health care for patients in a more efficient, less costly manner that boosts growth, patient flow, access and service innovation. In this session you will learn how to successfully implement a Lean Management Culture in a rural health care setting and how to organize a lean collaborative for rural hospitals and CAHs. Additionally, information will be provided about the Collaborative's results, lessons learned, and tips on how to spread a Lean Culture across the continuum of care.

#3 Will Bundling Work in Rural America? Analysis of the Feasibility and Consequences of Bundled Payments for Rural Health Providers and Patients
Ira Moscovice, PhD, Director, Upper Midwest Rural Health Research Center, Minneapolis, MN

This presentation will offer an assessment of the financial and quality challenges—and potential unintended consequences for rural providers and patients—of implementing bundled payments for acute and post-acute care episodes; (2) explore the possible impact on quality of care delivered under a facility-physician bundled payment system; and (3) describe potential modifications to current bundling proposals and additional steps CMS could take that will help address rural-specific issues.

Break

GENERAL SESSION
Changing Relationships within the Provider Community
Joseph S. Bujak MD, FACP, author of Inside the Physician Mind: Finding Common Ground with Doctors, Coeur Alene, ID

Relationships within the provider community are transforming. The historical covenant that governed these relationships is no longer valid. Health care economics, technology, demographics, and a shift in hierarchy of values are rendering the usual operating assumptions that have guided provider relationships obsolete. The provider community must adapt to these changes in unfamiliar ways, with robust strategies, and innovative models. We will discuss the implications of these transforming forces and provide insight into approaches that can guide adaptation with a special emphasis on how cultural differences complicate efforts to achieve the effective, efficient, appropriate, and patient-centered care that is required to achieve sustainable excellence.

Break

GENERAL SESSION 
Get off the Employee Engagement Roller Coaster:  Management Strategies to Transform Your Workplace
Vicki Hess, RN, MS, CSP, Principal, Catalyst Consulting, LLC, Owings Mills, MD

Talk to rural health care leaders today and they’ll tell you that trying to keep employees engaged is like a roller coaster ride with too many ups and downs, or that they feel like they’re on a merry-go-round, repeating the same things over and over and getting nowhere.  When did work start to feel like a not-so-amusing amusement park and what can be done to get out of the "fun house?"  In this engaging presentation, Vicki Hess reveals the “ups and downs” of management that influence or detract from employee engagement. Engaged employees have a sense of ownership and personal connection to work, so of course they improve results in all areas of patient care.  On the other hand, disengaged employees contribute to increases in staffing concerns, length of stay and the occurrence of never events.  Although engagement is a personal matter, Vicki shares specific, implementable strategies that busy leaders can adopt to create an environment that promotes a sense of personal ownership.

CONFERENCE CONCLUDES