What I’m working on right now: Supporting a new rural health network, National Rural Health Day plans and some health workforce initiatives.
My Top 3 Goals for 2017:
1. Getting my physical self back in line with my mental self through running.
2. Taking more time to reach out and appreciate people around me who are important to me, impact me, and inspire me.
3. Less procrastination- time pressure does not actually make me “work better”, despite all the excuses my brain tells me.
Favorite thing about working at a SORH: Variety! Every day is a new topic to learn about, challenge to overcome and inspiration to receive. I have never been surrounded by such passion,
knowledge and motivation both in my state and through all our national colleagues and partners.
If I weren’t doing this, I would be…saving the world through agricultural empowerment -AKA farming!
Best advice I ever received: A stranger once changed the course of my life with a few simple
statements. The paraphrased version: “That only we have the power to create the world we live in. Take the time to build intention in your life, even if it is just how you choose to view the day or a circumstance. Those small actions radiate in ways you never thought possible.” The simple act
of re-framing small things in my world has opened up doors and happiness I never thought possible!
People would be surprised if they knew: Prior to my public health work, I was a swim lesson instructor and Aquatics Director.
3 great things about rural health in Massachusetts: The 52% of landmass in my state that is rural is home to the most collaborative and innovative people and organizations. Despite inequities,
they find ways to take care of one another using incredible partnerships that span public, private and non profit entities. Nothing pleases me more than when an urban area wants to learn more about these innovative models happening in rural because they are astounded by the work happening!
Corporate sponsors are not only an important resource for funding for the mission of NOSORH, they are experts in rural health and often partners to the State Offices of Rural Health. This important work will be featured in a series of articles over the next few months.
For over a decade, State Offices of Rural Health have committed significant time and resources toward developing statewide Critical Access Hospital performance improvement networks. Likewise for over a decade Stroudwater Associates has supported the work of NOSORH and State Offices of Rural Health. . The result of this effort and focus has been the formation of mature, effective networks that enable CAHs to learn from one another, share performance data and collaborate on improvement projects.
“Stroudwater is proud to support the mission and goals of the National Organization of State Offices of Rural Health. In a rapidly changing environment with increasingly vulnerable rural providers and communities, we feel it is essential that organizations such as NOSORH continue to play a central, vital role in coordinating resources for state partners, hospitals, clinics and providers,” says Gregory Wolf, Principal with Stroudwater Associates.
Stroudwater Associates is a private healthcare consulting firm with corporate offices in Portland, Maine, Atlanta, Georgia, and Nashville, Tennessee, and experience working in all 50 states. Their Rural Team is passionate about the health of rural people and places. They tout their belief in relationship development, collaborative strategies, and commitment to personal learning and growth; with roughly half of their national practice committed to rural provider organizations.
Stroudwater supports nearly a dozen State Offices of Rural Health on their statewide performance improvement activities. Two SORH who recently shared their work on convening rural hospital networks that have a common partnership with Stroudwater Associates are the New York and Massachusetts Flex Programs.
In New York State, the Flex grant provides funding for a comprehensive performance improvement network that integrates Quality and Financial benchmarking, technical assistance and rapid-cycle projects for all of the state’s 19 CAHs. Every quarter the CEOs, CFOs and Quality Improvement Directors from every CAH across the state meet for a one-day Improvement Summit where market trends and updates are shared, state and national benchmarks are analyzed, and breakout sessions for collaborative improvement projects are convened. The New York SORH and Stroudwater partner on agenda development, meeting facilitation and methods for spreading the findings generated from the rapid-cycle project management process, the cornerstone of the Learning and Action Network. Karen Madden, the SORH Director and past NOSORH President, has witnessed the evolution of the CAH network: “Over the past several years we’ve seen increased involvement from all of our CAHs where we have almost 100% participation at every meeting from multiple managers from every hospital. But the most important advance for us has been the work that happens between our meetings. With the full implementation of the Learning and Action Network, the CAHs now work on collaborative improvement plans throughout the year and use the network meetings to learn from one another and share their successes. The level of engagement, accountability and improvement from our CAHs has been truly transformational.”
In Massachusetts, the Office of Rural Health faces a unique set of opportunities and challenges. The Commonwealth has a relatively small number of rural hospitals, most of those facilities are owned by large urban health systems, and two of the CAHs are located on islands. How does the Massachusetts SORH navigate this complex environment? “Our team has to be creative, flexible and highly collaborative,” states Cathleen McElligott, the SORH Director. “When we do our CAH network planning and consensus building with CEOs it’s essential that our Flex program activities factor in geography, hospital ownership and our state’s dynamic health reform environment. Stroudwater plays a key role in that process because they offer not just rural expertise, but also a higher level of credibility and knowledge to help our CAHs define and communicate the strategic relevance of our network activities to the health system leadership.” Like their counterparts in New York, the Massachusetts CAHs meet for full-day Improvement Summits throughout the year to review comparative analytics, address strategic and operational priorities and collaborate on rapid-cycle improvement activities.
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Cathleen McElligott is the Director of the Massachusetts State Office of Rural Health.
What are two of the biggest challenges your SORH faces and how do you meet them?
A big challenge for us, as a relatively small SORH, is making sure we continue to develop effective strategies with the greatest impact when there are so many rural health needs, and so much happening in the healthcare environment. It would be really easy to get side tracked off to 100 different directions each year. But these would not necessarily be teed up over time to really make a difference. To address this we work hard to think and plan strategically, as a staff and with our advisory groups and partners; to be clear on our purpose and vision; and develop multi-faceted and multi-year strategies. We measure each new opportunity against whether or not it is within the defined purpose of our office and whether it will lead to our vision. We determine what our role in the endeavor should be in order to make best use of our resources and those of our collaborators. We conduct background research, review data, and confer with our advisory council and partners to plan more deeply. Most important, we have learned that we need to engage in longer term, sequential, staged strategies to truly assess our options, develop multi-faceted approaches with partners, evaluate our progress, and sustain the successful parts of the effort over time.
A second big challenge is developing a rural voice that can be heard over the strong and pervasive urban thinking in our state. Our rural areas, of course, are furthest from the state capitol of Boston and its policy makers, and there are rather large healthcare organizations right in Boston that can easily dominate health care policy. Our response to this challenge has been to develop a strong network of rural health care leaders through our SORH rural health advisory group called MARCH (Massachusetts Rural Council on Health), build a communications and networking infrastructure using various modalities, and conduct activities to provide sound information, messaging, and tools to support rural health efforts. With this, the SORH has been able to develop a rural voice using local rural health care leaders to successfully impact state policy and programs to better address rural health care needs in our state.
What are some of the positive things going on right now in health care in Massachusetts?
In our state, we have made a very conscious decision, supported by the people of the Commonwealth, to strive for universal access to affordable health care coverage. So over about 15 years, with a thoughtful and collaborative partnership of all stakeholders, the policy, resources, and hard work have been put into place piece by piece to make this happen. As of 2011, Massachusetts reached the milestone of 97% of our population being covered by insurance; and now with additional recent changes as a result of ACA, initial reports are that we may be at 99+% insured now. In addition to ensuring access to health insurance, we are fortunate to work in a state that believes in making investments in community based innovations such as the Community Hospital Acceleration, Revitalization, and Transformation Investment Program (CHART), the Health Care Workforce Transformation Fund, the Prevention and Wellness Trust Fund, and Patient Centered Medical Home, E-Health, and Broadband Initiatives, etc. Our job in the State Office of Rural Health is to help to inform these new programs about the needs of rural providers and to assist our rural communities with accessing these important community health supports and performance improvement initiatives.
A project sponsored by the Massachusetts State Office of Rural Health (MA SORH) is helping rural hospitals in the state learn how to reduce the possibility of medication-related patient harm. With the Medication Safety Performance Improvement Project, the MA SORH has contracted with the Institute for Safe Medication Practices (ISMP) to perform one-day targeted medication safety risk assessments at the hospitals.
ISMP recently started offering these one-day medication safety assessments with small and rural hospitals in mind. Each hospital assessment visit focuses on one or two predetermined, mutually agreed upon topic areas in medication safety such as sterile compounding, oncology, medication use in the perioperative areas, or medication administration practices. The ISMP team meets with and interviews key hospital administrators, medical and clinical staff, and other hospital managers to gain an understanding of current medication use practices in the areas of focus. Although the hospital pharmacist takes the lead, it’s important that other hospital staff is included since they all have a role in medication safety, said Cathleen McElligott, director of the Massachusetts State Office of Rural Health.
At the conclusion of the visit, the ISMP team presents their findings through an interactive presentation. The focus of the presentation is to identify areas of risk exposure observed within the designated areas of focus and to make prioritized recommendations for change. Following the visit, ISMP creates a written report that describes specific medication safety recommendations and provides associated references and tools to assist with implementation of the safety strategies.
The project, which began in April of last year, has been piloted with four hospitals in the state. “It’s been so successful that we’re adding four more hospitals this spring,” McElligott said.
According to Ronnie Rom, MA Flex Coordinator, who began and now coordinates the pharmacy project, the facilities that have participated have noted significant improvements in medication storage, labeling, removal and verification processes. The project has also been a contributing factor to achieving 24/7 coverage sign-off at a couple of the facilities, Rom said. Participants have lauded the ISMP team for having “engaged hospital employees across disciplines and committees,” and for offering “concrete guidance to improve evaluation/measurement of patient safety.” In addition, Rom said, participants have shared that they have found it “especially helpful to have this opportunity be presented by the SORH as a healthy non-judgmental check-up vs. a problem-initiated visit.”
The New England Rural Health Roundtable provides reimbursement for the project with funds provided by the MA SORH’s Rural Hospital Flexibility Program. “We found the ISMP team highly professional and easy to work with,” Rom said. “We think other flex programs should take advantage of this,” McElligott added.
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