Child care for employees, the need to update and expand medical facilities, and the new electronic medical records system were some of the key points discussed during a strategic planning session for Powell Valley Healthcare last week.

Other topics during the April 8 meeting included addressing transportation needs for patients, the number of primary physicians needed, working cooperatively with other hospitals in the Big Horn Basin and a proposal for a community health center in Powell.

The best news was, this time around, the focus of the planning meeting was moving forward instead of looking back at a painful past.

“We didn’t spend a lot of time chewing on our recent problems,” said Bill Patten, chief executive officer at Powell Valley Healthcare. “We acknowledged that we are at a unique point in time, given our recent struggles, and there was a clear commitment from the rest of the group that we need to take advantage of this opportunity” to move the organization forward and make it better.

The mood at the meeting was positive, and most believe the organization is moving in the right direction, Patten said.

On-campus child care

Patten said child care clearly is a need for Powell Valley Healthcare employees, particularly for hours outside of the traditional business day and for sick children.

He noted that Powell’s biggest population age group consists of people between the ages of 18 and 44.

“With so many in our community of child bearing age, that’s a big deal. We need to offer off hours and sick-child care,” he said.

Patten said Nicole Ostermiller, director of Powell Valley Care Center, told him providing care for sick children would eliminate half of her employee call-ins for absences.

While the need is apparent, the way it might be met hasn’t been identified yet.

“Maybe we provide the facility and have someone else come in and run it for us,” he said. “The how is not so much important as the what: We need to provide on-campus child care.

“I have to believe there are other businesses in the community that would benefit from it. Maybe this is something we do cooperatively with the college and the schools and the community. I sort of like that even better.

“It excites me, the possibility of doing this,” Patten added, “but I struggle with, I won’t be able to do it tomorrow like I want to. Much of this is three, four, five years way. But in the big scheme of things, that’s still quick.”

FacilitIES master plan

Powell Valley Healthcare leaders are planning to reach out to the community in the near future for residents’ and leaders’ opinions on the best way to update and expand health care facilities.

Davis Partnership of Denver identified three alternatives for planning for facilities needs. The first, a bare-bones approach, was deemed incapable of meeting the organization’s needs. The second proposed significant changes to the Powell Valley Healthcare campus, meeting most needs, but not all; the third — also the most costly — would meet all the organization’s facility needs by building a new nursing home and converting the old one to patient care rooms and a maternity/obstetrical center.

It’s likely that the PVHC board ultimately will decide on some kind of a blend of the two remaining plans.

The board recently decided to delay making a decision to provide an opportunity to get feedback from members of the public about their visions for Powell Valley Healthcare.

“We put our planning efforts on hold so we could reach out to the community and say, ‘These are the challenges we face; what do you think we should do about it?’ rather than saying, ‘This is our solution. What do you think about it?’” Patten said.

A plan for conveying that information to the public is expected to be in place by April 29, and leaders will take their message to the community over the next three or four months.

“I had thought we would have this plan done by December. But I am convinced that this is the way to go,” Patten said.

Electronic medical records

Getting the new NextGen electronic medical records system operating and fully functional “is really an important part of us being successful in the future,” Patten said.

For instance, one of the complaints he hears frequently is that there can be long wait times in the ExpressCare Clinic, even when there is just one patient in the waiting room. That generally is caused by the time needed to send someone to get a patient’s medical record file, he said.

The hospital and financial systems went live for a second time on Jan. 29.

“We’re scheduling special trainings with physicians on the hospital system, first in group sessions, then on an individual basis, then closing with a group session where they can share their insights,” Patten said.

Some quirks showed up in the financial system, and staff are working through those with NextGen.

“I think if this was the first go live, people would be far more accepting; with it not being the first, people have a shorter fuse,” he said.

Powell Valley Clinic will go live in July or August after an upgrade is installed. That system will go live in phases, with Dr. Valerie Lengfelder, PVHC chief of staff, and Dr. Michael Tracy, Powell Valley Clinic medical director, leading the way. They will learn the system and work through any bugs, then other doctors will be added in stages.

“We think that’s better than the big bang where everyone jumped on at the same time last time,” Patten said.

More physicians needed?

Last year’s figures showed Powell Valley Healthcare might have “a smidge of a surplus” of primary care physicians, but this year’s indicate more are needed, Patten said.

“This year, it seems like the report is saying we need five or more additional,” he said. “I’ve asked for clarification, and I think one of the factors may be that, this year, we are looking at primary and secondary service areas. Last year, we were looking only at the primary service area.”

Transportation for patients

A lack of transportation can prevent people from getting the medical care they need. That can be true for older patients who aren’t able to drive, people with disabilities, people with low incomes and others for whom transportation is an impediment, Patten said.

“Access (to medical care) is impacted by more than the number of appointments available,” he said. “Transportation we normally don’t think of as being our job. But it’s something we’re going to have to look at. How do we get people here?”

Cooperating with other hospitals

Patten said he advocates working more cooperatively with other hospitals in the Big Horn Basin, “and not only in a way that says, ‘You send us your patients.’

“That’s one-sided,” he said. “How do we extend our providers so they can actually care for the Lovell patients at the Lovell hospital, understanding that then, any care that isn’t appropriate for the Lovell hospital might actually come to us. It’s a win-win; their volumes go up; our volumes go up.

“I’m convinced on a global scale that the providers in the Big Horn Basin need to be thinking about how we can work together so it’s not us against the Billings hospitals. We need to figure out how to cooperate and share the business.”

Community leadership

Patten said he believes Powell Valley Healthcare leaders need to change their mindset about their leadership role in the community, not only in regard to transportation, but also relating to other facets of care, such as dental health and mental health.

“Not that we’re going to gobble everybody up, but, how do we facilitate that those services are provided? How do we coordinate? If (those services) are not provided, how do we make sure they are provided?”

Patten said he recently visited with Bill and Sharon Baker, who are spearheading an effort to establish a community health center in Powell.

The visit focused on ways to move the project forward in a way that minimizes competition, yet still would provide care for people who need it.

Patten praised the work that the Heart Mountain Volunteer Medical Clinic does to assure that people who qualify can receive the care they need.

“I have complete respect for the role of the free clinic,” he said. “They have filled an important niche that was needed and prepared the table for this discussion.”

‘We have platters’

With Powell Valley Healthcare’s Journey 2 Excellence (the organization’s self-improvement plan, overseen by the Struder Group), the NextGen electronic medical records conversion, facility master planning and other important projects all under way at once, Patten said PVHC employees and leaders are stressed.

“Talk about having full plates,” he said. “We like to joke, ‘We don’t have plates anymore; we have platters.’”

When considering projects under way or proposed, rationale centers on whether a topic is important or urgent, he said.

“It was agreed, nothing should be deleted from the strategic plan. I asked if anything should be added, and my sanity was questioned,” he said, chuckling.

“I have often asked, ‘What can we afford to stop doing? So much is clearly so important. ... It’s either like we’re in finals week, or the week before finals. So much is going on, yet you know your performance on those finals is essential.

“It will get better,” he said. “There’s not a doubt in my mind that it will get better.”