Community engagement is crucial for the success of rural hospitals, this new CMO says.
To succeed in rural health, hospitals should capitalize on their close connection with the rural communities they serve, according to the new CMO of Methodist Fremont Health.
Michele Williams, MD, became the inaugural CMO of the 75-bed hospital that is part of Omaha, Nebraska-based Methodist Health System this month. Williams, who is a practicing emergency medicine physician, previously served as the hospital's emergency medicine medical director, and she will continue to serve in that role in addition to working as hospital CMO.
From a clinical perspective, rural hospitals such as Methodist Fremont Health compared to many hospitals in urban settings need to take advantage of their close relationship with the communities they serve, according to Williams.
"Most of our staff live in this community and we know the patients who we are taking care of," Williams says. "We have a strong connection with the community, which helps us know patients well and care for them better."
Rural hospitals should focus on community engagement, Williams explains.
"We have medical educators who get into our rural communities," Williams says. "For example, we have become a stroke ready certified hospital. Part of that capability is getting into the community and educating people about stroke and when they need to get to the hospital for care."
One of the challenges for rural hospitals is keeping patients at their facility because rural hospitals lack the breadth of specialty care that is found at larger urban hospitals. In the case of Methodist Fremont Health, the hospital strives to keep patients in Fremont rather than having them travel for care in Omaha, which is about a 35-minute drive.
"We have about six ambulance services that come into our emergency department from surrounding rural communities," Williams says. "A lot of these patients are from rural communities that are even smaller than Fremont, and they don't want to go to Omaha if they don't have to go there."
To help patients stay in Fremont, Methodist Fremont Health leans on the resources that can be provided by Methodist Health System.
"We are part of the Methodist Health System, which includes Methodist Hospital in Omaha," Williams says. "Being part of a health system helps us have resources such as consulting services that can help keep our patients in Fremont."
Rural hospitals struggle to remain financially sustainable, and Williams says one of her priorities is learning how she can help make sure clinical care is aligned with Methodist Fremont Health's financial goals.
"My role as CMO is to ensure that patient care and clinical medicine are the top considerations as we are making financial decisions," Williams says. "I need to be able to bring the clinical piece into discussions about finances."
Williams emphasizes the need to be involved in initiatives that lower cost of care such as shortening length of stay, promoting care standardization, reducing hospital readmissions, and decreasing hospital-acquired infections.
"I need to be the clinical voice in these discussions," Williams says. "I need to be engaged when we have meetings about hospital-acquired infection rates and readmission rates, then take those discussions back to the clinicians who are practicing. For example, I need to get feedback from clinicians about the challenges they face in readmissions."
Michele Williams, MD, is the new CMO of Methodist Fremont Health. Photo courtesy of Methodist Health System.
Promoting Quality and Patient Safety at Rural Hospitals
Williams has served as chair of the Methodist Fremont Health Patient Care Review Committee, which reviews adverse events and other concerns at the hospital.
The panel has medical staff representatives from multiple specialties at the hospital, including orthopedics, general surgery, anesthesia, internal medicine, pediatrics, radiology, and obstetrics. Case reviews can be initiated by patients or staff members, and the reviews include cases that have adverse outcomes related to morbidity and mortality.
"Representatives from these specialties come together and review cases," Williams says. "Physicians who sit on the committee are assigned cases to review. They interview the staff members who were involved in a case, then they bring a report back to the committee."
For effective case reviews, there must be an emphasis on a just culture, according to Williams.
"Just culture is the basis of our patient care reviews," Williams says. "We look at events and see how we can change processes. We do not engage in blame or accusatory actions in our patient care reviews."
Methodist Fremont Health has taken several steps to establish a just culture.
"We have a just culture orientation for any of our new hospital medical staff members," Williams says. "We also talk about the process of just culture and try to establish a culture where we discuss mistakes and concerns in an open way. When adverse events occur, staff members are not blamed or shamed."
Part of establishing a just culture is ensuring that staff members have psychological safety, Williams explains.
"There is open communication with any staff member involved in an adverse event or concern," Williams says. "If a staff member feels that an episode of care could have gone better, we want them to feel they can come forward and see how we can improve our patient care in the future."
Christopher Cheney is the CMO editor at HealthLeaders.
KEY TAKEAWAYS
The staff at rural hospitals tend to live in the communities they serve, which can drive clinical benefits because they know their patients well.
Rural hospitals that are part of health systems can keep patients at their rural facility by capitalizing on health system resources such as consultation services.
Rural hospitals can promote quality and patient safety by having a committee that conducts case reviews when there are adverse events or other concerns.