Q & A with rural hospital leaders

The COVID-19 pandemic strained hospitals, resulting in shortages of staff, supplies, and even space. Today, those effects are still being felt in health care systems across the nation. And that includes communities in rural Michigan.

Rural Innovation Exchange had the opportunity to speak with Munson Healthcare President Ed Ness and John Foss, senior vice president of operations, Trinity Health Shelby and Grand Haven, about some of those concerns. 

Munson Healthcare President Ed Ness

RIX: Can you start by telling me a little bit about the community in the area where your hospital is located?

Ness: Munson Healthcare is based in Traverse City but has a number of hospitals throughout Northern Michigan. Our service area is really the northern half of the state. We serve about 500,000 people north of U.S. 10. In most of our communities, we are the only hospital in town. We have a unique position and an opportunity to serve the healthcare needs of the rural upper half of the Lower Peninsula. 

What are some of the concerns that your hospitals across the healthcare system are experiencing right now?

Ness: Our challenges are not that different from healthcare seen across the country. Our biggest challenge is probably labor and talent attraction. Post-pandemic, we’ve really seen staffing challenges in some of our rural hospitals.

Ed NessIn urban areas, employees can move between one employer or hospital to another. We really need to relocate employees in our rural areas, especially nurses from other areas. With that, comes challenges of housing, and/or finding opportunities for their spouse or partner. We, like all employers, are challenged with staffing, which leads to not only higher cost, but also challenges in our operation. 

The pandemic obviously impacted all industries across the board when it came to staffing, but how did it impact staffing within the healthcare system specifically?

Ness: It impacted us in a couple ways. Because of some of the closures, some of our training programs had a gap during COVID. Some learning programs were interrupted, so we have a gap of a couple years where we didn’t have as many students coming through in the different fields. Enrollment in those programs has picked back up, but it will take a couple years for that to right itself. 

The pandemic was tough on the hospital staff, with all the difficult situations that they had to work with. For some, they just felt it was the right time to transition to another career, and get out of healthcare. We’re working really hard now post-pandemic to get people back in and excited about the healthcare field.

What sorts of things are you doing to attract talent or retain current employees?

Ness: For recruitment, we’re working on a couple different points. We’re working with schools to improve the pipeline back into healthcare. It starts at the high school level, but also goes to the community college level, so we’re doing lots of programs partnering with those schools to get people back into healthcare. 

We’re doing different marketing campaigns to communicate that we have openings and that Northern Michigan is a great place to live, and a great opportunity for them coming up. We’re also working with our own training programs to train not only nursing students, but some other technical fields as well. 

What concerns do you feel like rural healthcare systems have that vary from concerns of those in larger cities?

Ness: One of the things we’re really working on is improving access to care. Rural Michigan has its unique access issues, especially in the winter, because it’s hard to travel. 

We’re doing something called our regional care redesign, and doing a lot of work to improve access. Some of that is digital like virtual urgent care, or ask-a-nurse phone programs. We’re looking at expanding our outpatient sites so that people have better access to physicians in their community. 

What other types of concerns are you seeing?

Ness: We’re really focusing on improving access to reduce driving distances for folks. Again, we serve 500,000 people in a very large geography, so our focus is improving access and improving those resources. 

We think one of the biggest opportunities is going to be things like virtual care, telemedicine, and ask-a-nurse programs so that no matter where you are, you don’t have to get in a car and drive somewhere. The response has been great, and we are seeing a lot of use of it. I think it’s going to be a good tool for people in our region. 

Is there anything else you want to mention?

Ness: We’re really excited about the program we call our regional care redesign, which we kicked off last year. We’re trying to reposition our healthcare system to meet these changing needs of the healthcare environment. It’s about improving access by having better coordination. So as you go between sites, that care is better coordinated. We’re also working to build up Munson Medical Center in Traverse City as more of a regional referral center, so people don’t have to go downstate for their care. 

John Foss, senior vice president of operations, Trinity Health Shelby and Grand Haven. 

RIX: Can you start by telling me a little bit about the communities in the area where you serve?

Foss: In Shelby, we are a critical access hospital with 24 beds for inpatients. We have an outpatient area where we do infusions, transfusions and small procedures. We have an O.R. staffed with two general surgeons. We have an E.D. that’s 24/7, and four rural health offices that serve Oceana County. In the winter, there’s not a lot of folks around, but in the next month with vacationers starting to come up, we go to a few hundred thousand people that are in the county for the summer months. We then have to take care of all of those vacationers as well. 

John FossThe key for critical access to rural health is making sure we get our communities the services that they need. Along the Lakeshore, we have Muskegon, which is a bigger medical center that we’re associated with, and they have a lot of specialists.

Through COVID, we realized that telehealth can be leveraged. We are stroke-survey ready at Shelby, and we have neurologists from Grand Haven and Muskegon that can help our doctors as far as placement, and treatment. 

The other thing we do for our community is a community health needs assessment. We did that three years ago, and one of the things we saw was that specialty care was needed. My role was to figure out how to provide that here. We found out that urology and OBGYN services were lacking. Those are the pieces that we’re looking at bringing those specialty healthcare practices to the rural health area. 

What concerns do you feel like rural healthcare systems have that vary from concerns of those in larger cities?

Foss: The biggest concern, no matter where you are, is staffing and the loss of nurses. If you were on the edge of retirement, COVID sped that up. We had a lot of well-seasoned nurses who left, and we’re trying to bring them back part-time to keep them in the workforce. We don’t have a lot of new nurses going into the training, so we’re limited. Now we have to figure out how we staff our floors and make sure patients are being taken care of. 

In Shelby, we had four or five long-time nurses of 30-40 years retire. We were able to replace them fairly quickly, but that was certainly a concern knowing everyone is struggling with staffing. We really have to focus on how to get young people interested in becoming nurses, making it easier for them financially, and supporting them through training. 

What incentives are you seeing hospitals and healthcare systems do to attract talent and retain employees?

Foss: We ask our nurses what kind of hours they want to work. Employers have to be flexible on their full-time status. Not everybody wants to be full-time, some may want to be part-time and have weekends off. Being flexible with the schedule is crucial. There have also been retention bonuses and signing bonuses. The biggest thing is creating a place that they want to work, and one where they feel they have a say. We’ve done a lot of work at Shelby to make it feel like it’s a team and everybody’s a part of that team. If you’re the best place to work, people will find you. We have tuition reimbursement, and career ladders to help people become nurses. 

What specific concerns are you seeing when it comes to rural hospitals versus urban hospitals?

Foss: For us, the big thing was getting folks access to the internet. During the pandemic, when they went virtual with schools and some of the physician/patient interactions, we had people who didn’t have the internet come to the parking lot of the hospital or library. We have gotten close to 70% of our county with internet available now, which is huge for us.

Much of that specialty care can now be done virtually, or in one of our clinics instead of traveling 60-80 miles. We’re trying to provide those services locally the best we can to decrease their need to travel.

We’re also focused on access to medications. We’re sort of a wasteland when it comes to pharmacies, especially ones that help out folks who don’t have a lot of money. We have programs through Trinity where we provide a lot of medications to those folks, but they have to come to Muskegon. We’re working on ways to bring that pharmacy service closer to Oceana County. That will be one of our next focuses in the coming year. 

Looking ahead, what are some things your healthcare system is looking to implement?

Foss: We’re looking to see more virtual visits with specialists. The key for us is the new electronic health record we have together. We have that ability to connect individuals without having to travel. Leveraging technology is huge. The connectivity between the providers and the patients is so much easier. Making it convenient and easy for patients to use these resources really has to be our focus. 

Was there anything else you’d like to add?

Foss: Trinity Health Shelby has done a lot to continue to provide care for the community. The amount of support we have from our community is amazing … kudos to our community for supporting our hospital, and helping make it a shining star for Oceana County. 

Sarah Spohn is a Lansing native, but every day finds a new interesting person, place, or thing in towns all over Michigan, leaving her truly smitten with the mitten. She received her degrees in journalism and professional communications and provides coverage for various publications locally, regionally, and nationally — writing stories on small businesses, arts and culture, dining, community, and anything Michigan-made. You can find her in a record shop, a local concert, or eating one too many desserts at a bakery. If by chance, she’s not at any of those places, you can contact her at sarahspohn.news@gmail.com.
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