The Exec: How to Succeed in Rural Health

Retention of clinical staff is essential for success in rural health, this new regional CMO in Montana says.

A new regional CMO at Providence plans to bring a passion for rural health to his role.

Daniel Spoon, MD, became CMO of the Providence Montana Service Area on Sept. 22. A Montana native, Spoon previously served as director of research for the Providence Montana Service Area.

Retention of clinical staff is essential for success in rural health, according to Spoon.

"You need to find caregivers who want to work in rural communities," Spoon says.  "Then you need to create an environment where you can keep them.  Turnover in rural healthcare settings is huge, and it is destructive to being able to provide cohesive care over the long term."

Providing educational opportunities for clinical staff in rural settings helps create an environment that boosts retention, Spoon explains.

"You need to prepare staff members to take on the challenges of rural health," Spoon says. "When you look at critical access hospitals, it is lonely in the middle of the night to be an advanced practice provider working in the emergency room. You need to train APPs and other healthcare workers to work in that kind of environment and to be successful."

Spoon is working out of Providence St. Patrick Hospital in Missoula, Montana. The facility is a tertiary hospital for the region, and it provides training for caregivers who work in rural settings.

"This education boosts the confidence of clinical staff in rural areas in providing care for their patients," Spoon says.

In rural settings, it is crucial to have staff members practice at the top of their licensure, with a collaborative approach to care, according to Spoon.

"We need to motivate physicians, nurses, respiratory therapists, advanced practice providers, and other staff to come together to provide team-based care," Spoon says.

Transforming rural health requires harnessing data, and Spoon says he is uniquely positioned to lead that kind of an effort.

"In addition to serving as a regional CMO, I am the medical director of the cardiovascular innovation institute for the health system," Spoon says. "So I have a leadership role which gives the Providence Montana Service Area access to huge amounts of data. One of the things that is needed to revolutionize rural health is more data."

Healthcare facilities in rural communities such as critical access hospitals lack the kind of data infrastructure that is found at academic hospitals. Spoon hopes to overcome that challenge.

"My vision is to create an environment that harnesses the data available at Providence and to bring that data to our rural facilities," Spoon says.

Daniel Spoon, MD, is CMO of the Providence Montana Service Area. Photo courtesy of Providence.

Reducing Mortality Rates

One of Spoon's goals as CMO is to continue the region's work on reducing mortality rates.

"I am taking over a CMO role for a region where we have excellent collaborative leadership and low mortality rates as a starting point," Spoon says. "I am not coming into the regional CMO role to rebuild efforts to reduce mortality. I am coming in to encourage continuation of excellent clinical care."

Clinical leadership is pivotal in reducing mortality rates, according to Spoon.

"You need strong nursing leadership partnering with physician leadership and advanced practice provider leadership," Spoon says. "There needs to be a strong sense of collaborative leadership."

Data is key to decreasing mortality rates, Spoon explains.

"The data that supports mortality reduction is mainly specialty-dependent," Spoon says. "But in general, readmission rates are important. CAUTI and CLABSI rates are important. Pharmacy data is important to ensure you are giving the right prescriptions at the right time."

Processes are also essential to decrease mortality rates, according to Spoon.

"You should put a process in place for establishing a mortality reduction team," Spoon says. "This way, you have executive leadership and senior staff visibly supporting mortality reduction."

Health systems and hospitals seeking to decrease mortality rates need an institutional culture that includes building processes that ensure staff members feel safe bringing forward concerns about quality and patient safety, Spoon explains.

In addition, health systems and hospitals must build processes that promote clinician engagement and wellness to decrease mortality rates, according to Spoon.

"If clinicians are frustrated and burned out, their eyes will glaze over when you present them with data related to mortality," Spoon says.

Cohesion Drives Teamwork

Cohesion is an essential element of teamwork on care teams, according to Spoon.

"I love the concept of cohesion," Spoon says. "You should not leave cohesion up to chance. You need to purposefully build cohesion in your care teams to have them function at the highest level."

This involves several factors, Spoon explains.

"You need open and honest dialogue," Spoon says. "You need to have team members understand the ultimate goals of their efforts. You need to have a true appreciation for the different skillsets of individual team members. You need a leader of the team who does not need to micromanage. You need to have the right people in the right place understanding their roles and pulling in the same direction."

Debriefing is also a valuable tool in promoting care team cohesion.

"Particularly after a care team has experienced a difficult situation, debriefing is crucial," Spoon says. "It should be done in a way that team members feel safe in discussing what happened and what the team can do differently in the future to be more effective."