By Mary Alice Murphy

At the Gila Regional Medical Center Board of Trustees meeting on April 24, 2024, Chairman Dr. Fred Fox recognized two employees for their years of service. Neither was available for the meeting. Jaime Jaramillo has served 10 years at the Gila Family Practice, and Tiffany Rascon has served five year with Beginning Years.

With no public input, members reviewed the consent agenda.

Board member Will Hawkins asked if the board could allow questions before approving the consent agenda.

Member Pat McIntire said her concern is that the items are in the regular packet that only the board members receive, but there are no dollar signs on any other. "I am not comfortable approving without knowing the cost.

The items included:
Governing board meeting minutes from March 20, 2024;
•Resolution 2024-09 for renewal of professional services agreement of the cardiopulmonary medical director, Dr. John Stanley;
Resolution 2024-10 for replacement of the telecommunications system and wireless local network, which is grant funded;
Resolution 2024-11 amendment to extend the land use agreement for Air Methods Native Air helipad;
Resolution 2024-12 for renewal of the blood services agreement with Vitalant; and
Resolution 2024-13 for purchase of mini C-arms for imaging studies during operating room procedures.

Members approved the consent agenda after hearing the listed details, but no costs were given to the public.

With no old business or new business, the members next heard reports and updates.

The first item addressed board education and came from Director of Quality Ramona Wilson. It addressed the acquisitions of a tool to facilitate alcohol and substance testing in the emergency room.

Wilson noted it will be integrated into the hospital's standard practices. "We can screen for alcohol use with the SBIRT program to reduce trauma and to increase patient insight and motivation toward making a behavioral change. The key to the program is to link patients to community sources for monitoring and intervention. We will refer a patient to resources if they want to talk about the alcohol issue they have. I'm meeting with the New Mexico Department of Health on how we will incorporate the program to meet the needs of the community. We anticipate that about 5 percent of the patients will require referral. We have limited resources, with Tu Casa, HMS (Hidalgo Medical Services), Recovery Management, and Border Area Mental Health." She also listed ones in Deming and in Catron County.

Board Member Jason Amaro asked how the person presents to be assessed.

Wilson said the emergency department staff would receive two days of training. "It's great that we have a voice in developing a program in areas around New Mexico. Most hospitals have already accepted the program. I would like to bring it forward in May. A patient will receive a health questionnaire in registration before being triaged. A nurse will review the responses and score the patient for low, moderate or high risk. The patient may not want to talk about it, but we are initiating the process. The benefit is surveying the community, and a lot have issues with alcohol or substance abuse. We hope to get them into treatment before they develop cirrhosis or other problems." She said the hospital will receive $7500 to help develop the program.

Wilson has planned a pilot test of the program during a 12-hour shift in May at the Emergency Room, and then the effort will focus on getting Gila Regional to be certified in the program.

Board member Will Hawkins said: "This all fits in with how we are connecting our community resources."

Wilson said she was really excited to implement the program, and "we're almost ready to implement it."

The next report came from Chief Nursing Officer Ron Green. He gave kudos to Wilson for taking the lead in bringing the SBIRT program to Gila Regional. He noted that the hospital is keeping on track with providing an annual skills fair on May 2 and 3. "It's a refresher course, and we have also invited the nursing students from Western New Mexico University."

Green announced the hospital would celebrate Nurses' Week May 6-10, with various activities planned.

He also said that between January and March, the hospital had already received 19 nominations for the annual Daisy Award, which recognizes a nurse for exceptional care to patients. He encouraged more nominations and said the annual ceremony will take place in October.

Green reported the construction on the Maternal and Child renovation was going well, with an expected completion by late May, early June.

He noted that staffing remains a challenge."We have 12 travelers. We are continuing to discuss marketing strategies to bring permanent nurses to the facility."

Chief Executive Officer Robert Whitaker said the hospital is considering financial incentives for new hires that will require them to stay for a certain length of time.

Interim Chief Financial Officer Tim Johnson said the financial statement was self-explanatory. [Author's Note: I never received the report. I do have the one for May, and will expand on the numbers more at that meeting.] Johnson noted the capital budget process is underway. "It's pretty extensive, and we are trying to get feedback from all the department directors."

He said overall, inpatient revenue was down year-over-year but it was not unexpected. "That makes a big impact. It's speculation on my part, but I think the increase last year and the year before was due to demand for procedures that weren't done during the Covid years of 2020 and 2021."

Johnson said the cash balance dropped by $25,000. "I don't anticipate that happening again on my watch. We are making quite a few changes and operational initiatives to ensure that balance continues to build for the health of the hospital going forward. We're making changes in the revenue cycle. We want to capture all the revenue that we are supposed to."

He said one of the things they are addressing is breaking down the silos in the hospital. "We're working to build folks internally and also bring folks to the community that will support our efforts. A lot of our people have worked only at Gila Regional and haven't had experience in other hospitals or medical centers. So, we're trying to take some of those folks who have had other experiences to train the ones who haven't. We're working hard through education and training, as well as through mentoring and support. So far, it's been awesome."

Johnson said he works with the controller every day so "she can learn enough to someday replace me. She is qualified to be controller, and I want to bring people up within the organization. She is really extraordinary at accounting, but she hasn't worked in finance or revenue cycles, but we all learn in our jobs, right?"

Whitaker noted that an employee health protection preventionzist had been promoted from within. "Our trauma coordinator was a promotion from within, and so was our registration supervisor. And so was our Chief Nursing officer brought up from within Gila Regional."

Amaro said he is glad to see the promotions within the organization. "I've been at other hospitals where the leadership had a formal process of identifying local people with leadership potential and then fostering them to promote them."

Vice President Betty Vega said she would like to see the process be quantifiable, and people in the community need to hear about these promotions.

"Absolutely," Johnson said. "Anything we can do to build our community. We celebrate those promoted from within, as well as those who come from outside the area."

Fox said they are talking about bringing people up from within the organization, which should motivate the employees to get the training to better themselves.

Hawkins said the issue had been one of the concerns of the board retreat, so he appreciated leadership thinking about the issue. "We must make sure our leadership is representative of the community."

Johnson said everyone in financial before his and Whitaker's arrivals had worked really hard to bring financial stability to the hospital. "We got there, and now we have to prove financial viability and growth, as well as where we will be five or 10 years from now."

The chief of staff report from Dr. Colicia Meyerowitz would take place in executive session.

Whitaker, as part of his report, said the orthopedic clinic renovation was still underway. He thanked staff for bringing in new replacement capital equipment and getting them set up for use. He noted the approval of the phone and wireless systems would allow work to begin on them and would give them options for specific Caller ID, such as for the Cancer Center. The telemetry system was funded with $900,000, so that work, too, will soon begin. "After that one is complete, we'll go to our nurse call project to replace the nurse call system. That, too, received grant funding."

"I think the staff is excited to see the new equipment because it confirms the financial stability of the hospital," Green said.

Whitaker said he does department rounding as a way to meet individuals as they go about their jobs.

Whitaker reported that the GRMC Foundation had a picnic planned for employees, and a gala planned for October.

"We're working on a strategic marketing plan," he said. "I'm looking at the fall for a time for the board to work on it. You need to decide if you want to do a full day or two half days. Julie Haynes of Health Tech will help engage with us."

He noted that he has been working with Silver Schools to get some students to come to the hospital. "We're opening up 10 slots for someone with an interest in graphics, maintenance or clinical aspects, but no one will have patient contact. Once we get it figured out we'll approach Cobre and Aldo Leopold schools, too."

Whitaker said the renovation of the orthopedic clinic area is ongoing. "We have to rework the parking lot, and we expect to finish the middle to the end of June."

Carolyn St. Charles of Health Tech gave the company report. She said she had brought two colleagues with her to do a mock survey. "You're two years out from another Joint Commission survey, but I like to give the hospital plenty of time to remedy anything we find with the mock survey. The last survey in general required a lot of just quick fixes. Overall, it was a good survey."

Wilson said: "When Carolyn comes, I want to see a really good survey. I enjoy an in depth survey. It's a lot of work but it engages almost everyone in the hospital."

"Cheri and I talk to staff members, not just the leadership," St. Charles said. "When the Joint Commission comes in, they want to work with staff."

To a question from Fox, St. Charles said: "Yes, we hit every department, although we did miss one clinic today. When we are in a department we look at medical records and we ask lots of questions. Dan looks at the EOC (equal opportunity commission) side in depth at safety and the environment. You never know what a surveyor will focus on. We hit many areas that the surveyors look at."

Whitaker said the team did a process tracer, which looks at the path a patient takes in flowing from the ER or registration to a room. It follows the life safety of one patient.

St. Charles said the staff did a great job.

Health Tech Patrick Banks said he would return to Gila Regional in May to look at some of the systems.

The board went into executive session. After the closed session, the members approved in open session, the Medical Staff Executive Committee provider credentialing report and approved the proposed bylaws, rules and regulations amendments.