Strategic Initiatives and Process for Public Participation

Summary of NCHS Strategic Planning Process

The Strategic Planning process at North Country Health System (NCHS) is an on-going process. NCHS has historically carried out strategic planning efforts in response to changes in the health care environment and the local health care marketplace, as well as in response to identified opportunities and needs of the citizens living in the hospital’s service area. The Strategic Planning Committee includes community members and meets regularly. The process includes the following:

• In coordination with the Finance Committee, review and revise North Country Hospital’s (NCH) Capital Expenditure Plan as needed
• Conduct an on-going assessment of NCHS facility needs for the next five years
• Identify and strengthen NCHS’s current stature in the community
• Develop strategies to ensure adequately trained staff are available in the decreasing work population
• Identify and examine joint ventures/diversification with physicians or other interested groups to stabilize physician retention
• Continue to identify unmet community needs and develop supports to meet those needs as possible
• Continue the development and implementation of an integrated Information System for NCHS
• Create an environment that encourages and fosters active and on-going participation at all levels in performance improvement and safety compliance
• Review and update the NCHS mission statement
• Foster and support philanthropic initiatives
• Proactively plan and respond to health care reform issues

Strategic Planning Initiatives

The Board of Trustees meets annually at a retreat, at which time they update the planning initiatives. The current initiatives for 2008 - 2012 are:

Board Retreat – Strategic Planning Outcomes
Statements of Direction (what our goals are based upon)

1. Retain high performing physicians and employees
2. Plan for recruitment/succession/exits
3. Improve efficiency
4. Build a quality infrastructure
5. Responsibly capitalize on areas that make us money
6. Move market share up

Statements of Approach (to be considered when developing strategies)

1. Collaboration/partnership/outreach
2. Patient centered (i.e. whole person, education)

As a result of our strategic planning process, review of relevant data and assessing the healthcare needs of our community, the hospital is undertaking the following three key initiatives:

1. Diabetes Management and Education
As one of its quality measures, North Country Health System focuses attention on the care of patients with diabetes. According to data from the VT Department of Health, this chronic condition occurs in a greater percentage of our population than other areas of the state. While the VT rate is only 5.1%, one of the lowest in the country, the rate in Orleans County is 7.0%, similar to that of the US at 7.1%.

Management of this condition depends on many factors, including appropriate testing, medication management, patient education and patient self-management especially regarding the balance between dietary intake and physical activity. One of the initial steps was to assure consistency in our patient education process. Through the work of our providers and diabetes educators, we now have consistent, up-to-date educational materials available within the hospital and in all our physician practices. Additionally, educational materials are readily made available to the community. Many departments have also selected quality improvement goals focusing on various elements of diabetic care.

As a measure of diabetes management, as a system goal, we selected Hemoglobin (Hgb) A1c, a fraction of hemoglobin found in all of us which gives us an average of what our blood sugar is over a three month period. Our goal was to increase to 65% the percentage of diabetic patients age 18 to 65 years who have a HgbA1c < 7%. Record review for the period of October 2006 through June 2007 shows a baseline of 62.5% of diabetic patients meeting this goal. Through the work of our providers and staff we were able to increase this rate to over 65% of our target patient population, well above the national rate of 37%.

During FY’08, an interdisciplinary Diabetes Management Team was formed. With guidance from our providers and pharmacists, the team is helping the hospital move toward the basal-bolus system of insulin therapy. The team has also identified and documented the strategies currently implemented by various departments regarding care and education of patients with diabetes. Mechanisms are also in place to raise community awareness about diabetes and to provide community-based education. Providers, members of the Board’s Strategic Planning Committee and the Diabetes Management Team are all working together to specifically identify the goal for FY’09.

2. Physician Recruitment
To meet the needs of our communities for access to primary care, North Country Health System has established annual goals for recruitment of primary care providers. Our short-term goal is to recruit one additional Internal Medicine physician, two Family Medicine physicians and one Family Medicine mid-level practitioner.

To accomplish this goal, our recruitment strategy includes several simultaneous approaches to reach and recruit physicians and mid-levels.

Retained Search. We have contracted with a retained search firm that guarantees results or they refund their professional fee. One of the physician searches is being conducted by a retained search. Under this approach, an up-front fee is paid and a focused search is conducted until a candidate is hired.

Contingency Search. We have agreements with over 10 contingency search firms to recruit primary care physicians. Under this approach, a fee is paid to the firm once a physician is hired that was sourced by the firm.

On-line Job Boards. Web-based job boards are utilized to post our physician opportunities. The boards that are utilized are by physician specialty.

Direct Mail Campaigns. Mailers are sent to licensed physicians in the New England area, plus resident physicians who will complete their resident programs in 2009.

Journal Advertising. Ads are regularly placed in physician journals.

Job Fairs. We attend several New England job fairs where prospective candidates who are seeking jobs are invited to meet with employers.

3. New Medical Office Building
On May 20, 2008 North Country Health System received a letter from the Commissioner of the Department of Banking, Insurance, Securities, & Health Care Administration (BISHCA) officially approving the construction of a new medical office building on the hospital campus. The 22,000 square foot building will provide much needed space for two of the hospital’s primary care practices.

North Country also went before the Development Review Board (DRB) of Newport on Tuesday, May 13, 2008. The DRB granted site plan approval, a zoning permit, and confirmation the building project meets the local Act 250 criteria. Pending permits include the State Act 250 Land Use Permit, storm water permit, and an archeological evaluation. If everything goes as planned, construction on a new medical office building will begin on the campus of North Country Hospital in July. Construction will be approximately twelve to thirteen months

Long term strategic planning addressing the lack of access to primary care in our service area determined that construction of the new medical office building was the best solution for meeting the primary care needs of the area. While Family Practice of Newport (FPN) and Community Medical Associates (CMA) will remain two separate practices, sharing the building offers many advantages and cost savings. The new building will also be larger to allow these practices to expand to meet the primary care needs of the community. North Country plans to expand primary care services by recruiting five new primary care providers.
FPN and CMA currently provide healthcare services to a total of 9,500 individuals, with 30,000 patient visits each year. Between the two practices, the providers care for the medical needs of about one third of the 30,000 people in the North Country coverage region.
Without the development of this project, the population of the Newport Service Area will continue to experience problems with availability and accessibility to needed primary care services. Vermont encourages patients to find a personal provider whom they use consistently for all their primary care needs. If a patient finds his/her primary care needs cannot be met in a timely manner by his/her provider, he/she will seek an alternate source of care. This alternate care is often provided by the hospital's emergency room.

The summary and description of the items above will be updated annually, as changes occur and as the hospital service area’s identified needs change.

How to Obtain Information

Consumers may obtain detailed information about, or a copy of, the hospital’s strategic plan, its one- and four –year capital expenditure plan and a depreciation schedule for existing facilities from the North Country Hospital Administrative Office at 334-3202; North Country Hospital, Administration Department, 189 Prouty Drive, Newport, VT 05855; FAX 802.334.3240.

Mechanisms for Incorporating Meaningful Public Participation

North Country Health System is governed by community members on our Board of Trustees. It is these representatives of the public, from all walks of life, who are stewards of our resources, and make the operational and long term capital and strategic planning decisions that propel our goals and sustain our future. Additional community members participate on the Quality and Finance Committees.

North Country Health System, as a leading provider of healthcare to communities in Orleans County and the northern part of Essex County, conducted a healthcare needs assessment of the communities it serves during the autumn of 2004. The purpose of the assessment was to help communities identify healthcare needs, establish priorities based on these identified needs, and establish priorities around the resources required to meet these needs. The results of the assessment are summarized in the North Country Community Assessment Report for 2004.

Since then, NCHS has periodically made available several forums and surveys to the residents of the NCHS service area. Updates to that report have been provided annually on our website and at a public forum held each year following the publishing of the Hospital Report Card.

NCHS regularly informs the public about health initiatives, services, programs, hospital personnel, and events through news releases, ads, flyers, radio, newsletters, the Annual Report, brochures and our website, www.nchsi.org

Additionally, NCHS has a number of mechanisms in place to receive comments and input from community members regarding healthcare needs, healthcare resources and priorities. These mechanisms will continue and include at least the following:

• North Country Health System’s current participation and collaboration in several community-wide partnerships and groups that focus on a variety of community needs – health, education, economic, social, environmental – just to name a few. These partnerships are listed below.
• Public open houses for community members to visit and view new services and/ or newly renovated departments.
• Invitation for the public to attend the NCHS Annual Meeting and receive annual report
• North Country Health System’s staff – We are a small community. Over 450 people work here either full or part time. Another 60 people are hospital volunteers. Comments from family and friends are continuously brought to our attention.
• Results of patient satisfaction surveys, both inpatient and outpatient.
• A staff member who focuses half time on receiving, communicating, and resolving patient concerns.

One of the primary mechanisms for receiving input from the community is North Country Hospital’s participation in, and collaboration with, a number of community-wide partnerships that focus on various aspects of the communities it serves. Following is a list of some of these groups. This list is not in any particular order, nor is it all-inclusive:

• Orleans Northern Essex Community Partnership
• Orleans and Northern Essex Emergency Response Teams
• Northeast Kingdom Collaborative
• Lake Region Community Action Network
• Newport Rotary
• North Country Chamber of Commerce
• Northeast Kingdom Long Term Care Coalition
• Northeast Kingdom Palliative Care Initiative
• School and Community Crisis Response Team
• North Country Hospital Volunteers and Auxiliary

The hospital utilizes both teen volunteers (Candy Stripers) and adult volunteers. They are involved in everything from greeting patients to shredding documents to delivering flowers. Our Chaplaincy Program volunteers come from many area churches to serve our patients and their families. The Hospital Auxiliary is another avenue for participation. The Auxiliary raises funds for the hospital through various events and operate the hospital gift shop. The Auxiliary meets in October, February and May, at which time they receive a comprehensive update from senior leadership.

Individuals who wish more information about opportunities to participate may contact North Country Hospital Administrative Office at 334-3202; North Country Hospital, Administration Department, 189 Prouty Drive, Newport, VT 05855; FAX 802.334.3240; or visit our website at www.nchsi.org.