How Community Investment Saved a Rural Health System

00;00;01;01 - 00;00;23;14
Tom Haederle
Sometimes having your back to the wall coaxes out the best effort. Some years ago, Mackinac Straits Health System was the 15 bed Critical Access Hospital serving Michigan's Upper Peninsula. It was in critical condition itself, operating on a cash reserve of just 3 to 5 days. But by making some very difficult decisions and pairing with some very strategic partners.

00;00;23;22 - 00;00;31;14
Tom Haederle
Mackinac Straits has really turned things around and today is in a much stronger position to deliver the health care its community counts on.

00;00;37;25 - 00;01;07;19
Tom Haederle
Welcome to Community Cornerstones: Conversations with Rural Hospitals in America, a new series from the American Hospital Association. I'm Tom Haederle with AHA Communications. Mackinac Straits Health System has worked with just about everyone, including local, state and federal partners, to save what had looked like a sinking ship. Locally, the Mackinac Tribe made a critical difference, donating both land and money that allowed the health system to undertake a badly needed expansion.

00;01;07;22 - 00;01;23;15
Tom Haederle
In this podcast, Mackinac President and CEO Karen Cheeseman describes the long and carefully planned out process that led to the final recovery of a rural health system. She is speaking with Samantha Borow, program manager of the Population Health Team with AHA.

00;01;24;08 - 00;01;44;16
Samantha Borow
Good morning. This is Samantha Borow from the American Hospital Association. I'm a program manager on the Population Health Team, and today I'm joined with our guest speaker, Karen Cheeseman. She is the president and CEO of Mackinaw Straits Health System in St. Ignace Michigan. Welcome to the podcast, Karen. So great to see you.

00;01;44;23 - 00;01;47;24
Karen Cheeseman
Thank you, Samantha. Appreciate the opportunity to be here this morning.

00;01;48;00 - 00;02;13;28
Samantha Borow
Sure. So we wanted to talk a little bit today about some of the topics we covered in our pre-conference session, which was on multi-sector partnerships for community investment in rural health. And yesterday you described your hospital's 20 year evolution and all of the successes and setbacks that happened along that way. So I'm wondering if you can just take a quick couple of minutes here to do a high level overview of that journey.

00;02;13;29 - 00;02;18;16
Samantha Borow
Where did you start? What were some key milestones and how did you engage the community in that process?

00;02;18;25 - 00;02;45;28
Karen Cheeseman
Sure. Be happy too, Samantha. Thanks for the opportunity here this morning. So I'll start with a little bit of background. Mackinac Staights Health System is located in the eastern Upper Peninsula of Michigan in a small rural community. And we started back in 1954. Little additional background. We're a 15 bed critical access hospital. We have an attached nursing home.

00;02;46;00 - 00;03;16;13
Karen Cheeseman
We have a number of specialists that are on our team and providing care. We have outpatient surgery as well as the rural health clinics. We started our journey in a very compromised state, operating on about 3 to 5 days of cash. We were that hospital that was identified on the map with a red star that was in a very critical state, and we had some difficult decisions that had to be made in order to move our health system forward.

00;03;17;04 - 00;03;48;09
Karen Cheeseman
So in order to do that, one of the first things that we had to address was the building itself. We were in a very dated building. We were landlocked. We didn't have the ability to expand on our current footprint. And we were having a very difficult time meeting the life health and safety codes. So we had to, in order to move forward, we had to develop a complete revamp of our strategic plan, and that included a new building to grow the health system.

00;03;49;04 - 00;04;23;11
Karen Cheeseman
So in order to do that, we began working very closely and at multiple levels on a local level, a state and a federal level to to begin plans to build the hospital. We ultimately determined that we would work with the U.S. Department of Agriculture, the small and rural development community funds to move us forward. We identified a series of of key points that occurred over about a ten year span, and that allowed us to secure the funding necessary to move forward.

00;04;24;02 - 00;04;50;20
Karen Cheeseman
So the first piece that we identified was the funding for the hospital itself and which we were successful in. A key piece along that journey was our relationship with our local tribal community. The tribe was instrumental in our our journey and our ability to move forward. They donated the the land that the hospital sits on today. So 16 acres.

00;04;51;02 - 00;05;15;10
Karen Cheeseman
They also made the first significant financial contribution allowing us to move forward. So if you look back and you look at how the hospital was operating at that time on a very limited supply of cash, that was really critical, a very critical step to allow us to move forward. As we looked we identified the needs. One of the critical needs was also our nursing home, which was very dated at the time.

00;05;16;02 - 00;05;44;26
Karen Cheeseman
And it was time to provide an appropriate setting for our residents and her and our families doing the right thing at the right time for the community. So we had to make a decision. If we would have constructed our outpatient surgical center first, it would have enhanced our revenue stream quickly, which was needed. However, we felt that the nursing home and the needs that were present at that time were more important.

00;05;45;14 - 00;06;11;19
Karen Cheeseman
So we made the decision with our leadership team and with the support of the board and the trustees to construct the nursing home. We knew that the outpatient surgical services would follow and that revenue would would come at the right time. And that's exactly what we did. And we've not looked back on that since. As outpatients surgery moved forward, we were able to to really grow, and that's where we really saw things begin to take off.

00;06;12;08 - 00;06;47;06
Karen Cheeseman
We were able to recruit the specialists to the system and allow that center to to move forward successfully. Two of the things that I touched on yesterday also that were key to that growth was a strong orthopedic service line, along with a spine program both up and running and very successful today. And all of these things that I touch on are important because if we weren't providing that care in our community, our community would be driving great distances to seek that care upwards of anywhere from 50 to 100 plus miles.

00;06;47;23 - 00;06;55;01
Karen Cheeseman
So anything that we can do locally in the community is removing those barriers for care for our patients.

00;06;55;16 - 00;07;12;10
Samantha Borow
Thank you so much for that overview. It's so great to hear the story of your journey. One thing that you touched on was those strong partnerships with the community in order to better serve them so I'm wondering if you could talk about that a little bit more. How did you build those relationships? How did you rebuild those relationships?

00;07;12;10 - 00;07;21;21
Samantha Borow
As we know, this work all depends on strong foundations of mutual trust. So if you could talk a little bit more in depth about that journey with the local community.

00;07;22;01 - 00;07;48;17
Karen Cheeseman
Sure. I think you're looking back, the the relationships were critical in our success. And I mentioned the tribal component earlier. One of the first things that that got us up and running in this process and the tribe was in a similar situation that that we were at the time. They were very restricted on space. They also wanted to grow their services.

00;07;48;26 - 00;08;19;10
Karen Cheeseman
And so throughout those discussions in those strategic planning sessions, it was determined that we could really work together for the benefit of our community and without duplicating services. And I think we've done a a really great job at doing that. And not only I think it's really important to say and to point out it's important that you build the trust, but you also have to work to maintain and keep that relationship going.

00;08;19;23 - 00;08;44;03
Karen Cheeseman
And again, I think a great example of the things we've been able to do over the last several years. Along with that, we we had a number of different partnerships at the local level. We also worked with our state partners and our federal partners. We relied on our Michigan Health and Hospital Association for guidance throughout the process.

00;08;44;04 - 00;09;16;28
Karen Cheeseman
We also worked very closely with the Michigan Center for Rural Health, both great partners to us. We joke that we are the hospital that has had Senator Stabenow visit the greatest number of times. She was one of our significant champions of health care who can relate to rural health and in our needs. And she again strong supporter and really helped us attain some of our funding and helped us navigate the complexities of the funding throughout the last several years.

00;09;17;14 - 00;09;44;26
Samantha Borow
So thank you so much for sharing this journey that you've been on. It is so important to have that support coming from a variety of both the local community and all of the government systems that are at play here. So it's great to hear that you were able to build that strong coalition. If you were to start this journey again today, or if you know someone that is, you know, a rural hospital leader that's looking to do this, what sort of strategical or tactical advice would you offer knowing now what you should have known then?

00;09;45;13 - 00;10;13;05
Karen Cheeseman
I would advise to to really work hard to leverage your relationships at multiple levels, use your team and your resources wisely. Use your legislative teams and support mechanisms, state and federal, local, all of the above. Be prepared to hear no at times, and be prepared to continue to work hard for what's right for your community in the health care that they deserve.

00;10;13;20 - 00;10;21;11
Karen Cheeseman
Again, be prepared to get knocked down and get back up and look for partners who are going to support you in this journey.

00;10;21;17 - 00;10;43;11
Samantha Borow
Wonderful. And we know the value of partnerships. So it's so great to hear that you've put those together for your system and again, doing the right thing for your community has been front and center in all of your work. So just one last question for you is that we know that right now workforce challenges are really something that are facing hospitals across the United States right now.

00;10;43;25 - 00;11;01;16
Samantha Borow
So we heard yesterday that you've managed to attract a lot of staff and expand your clinical service lines and by really focusing on the needs of your workforce. So if you could just talk a little bit about what tactics a leader should consider when trying to address those workforce challenges at their own systems.

00;11;01;29 - 00;11;32;05
Karen Cheeseman
Workforce is certainly a challenge right now for for all of us. A very common thread throughout as we look at how we rebuild health care over the next number of years. I think it's really important to look at doing things differently. I remember years back when we actually had waiting lists for individuals, potential employees who are looking to join the organization and certainly things look a lot differently today.

00;11;32;21 - 00;12;03;16
Karen Cheeseman
So I think it's important to look out and knowing what you once did will not be what you do moving forward. So how can you get innovative and creative to attract the workforce that you need? I think cultures speaks volumes for employers today. So again, what type of employee do you need to support you or your culture in the care that you were delivering are really important and be flexible.

00;12;03;21 - 00;12;31;03
Karen Cheeseman
Maybe you're looking at, you know, a hybrid type of work scenario. Maybe you're looking to provide some additional flexibility for a young mother who may not have childcare. Maybe you're looking to provide support for an employee who is caring for an aging parent. I think all of those things have to be looked at and and considered today. And I think we have to have a tremendous amount of flexibility.

00;12;31;16 - 00;13;00;15
Karen Cheeseman
I think we also have to look at what we can do to grow our own programs internally where prior say, we may have been able to rely on external certification programs, maybe lean a little more heavily on our local community colleges and universities. Today, we're all fighting for the same labor pool and the same resources. So as we're looking out at Mackinaw Straits, we're looking at what we can do internally to grow our own program.

00;13;00;28 - 00;13;24;28
Karen Cheeseman
So that may include a nurse aid training program to support the nursing home. That may include a medical assistant apprenticeship program that will support our rural health clinics. That may also include a nurse resiliency program where we are partnering very closely with our first year hires for nurses, where we know that time period is really critical for retention.

00;13;25;16 - 00;13;44;01
Karen Cheeseman
So I think we can't limit ourselves to one or two things. I think it's a variety of things that we have to look at going forward. And I think we have to be very prepared to be nimble and adjust to our environments and expect that that will change frequently as we rebuild our workforce over the next several years.

00;13;44;10 - 00;14;10;00
Samantha Borow
Yeah, So the creativity and the innovation and the tenacity that you have is something to be admired. So thank you so much for coming and to join us today and share your thoughts and your experiences. We invite those who are listening, who are interested in learning more about community investment to visit AHA's page. We have a lot of resources from leaders across the country in a variety of settings, and we are constantly evolving that page.

00;14;10;00 - 00;14;18;08
Samantha Borow
So please continue to check back with us there. aha.org/communityinvestments. Thanks again, Karen, so much for joining us.

00;14;18;11 - 00;14;19;08
Karen Cheeseman
Thank you for having me.