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EPHC board faces daunting changes

Tahoe Forest Hospital District CEO Harry Weiss spoke to Eastern Plumas Health Care’s Board of Directors about what they should look for as they begin another CEO search. Weiss has helmed TFHD for four years, but he has 42 years of experience in rural health care. Photo submitted

Eastern Plumas Health Care’s board meeting Dec. 5 focused on significant recent changes at the executive and management level. These changes include the termination of the CEO and CNO after only a year on the job, the removal of the ambulance services manager, and the resignation of the directors of nursing at both the Portola and Loyalton skilled nursing facilities (SNFs), all of whom had been on the job for less than a year.

The board has brought Jayne O’Flanagan out of retirement for a second time to serve as the hospital’s acting CEO, which lends vital continuity to that role. And, the hospital has rehired Lorraine Noble, who will now be director of nursing for both SNFs, again adding continuity and an understanding of state requirements, which is essential to that position.

Capable employees are taking on the CNO and ambulance service positions on an interim basis. The hospital has also seen the return of HR Director Lori Tange, who comes with an impressive resume and an assertive, positive attitude.

CEO recruitment

Discussion centered on what traits the board needs to look for as they begin the hiring process once again for a new permanent CEO.

The board was candid about its need to understand the recruitment process better in order to hire a CEO that is capable of leading the hospital.

Board Vice Chairman Paul Swanson asked Jayne O’Flanagan, who took on the acting CEO role for the second time in just over a year, “Since you’ve seen us go through this, what are your insights of what we most need to hear?”

O’Flanagan answered that, in her observation of the board and the organization as a whole, “Much of the practices and many methods are relaxed. There’s a great need for structure.”

To that end, O’Flanagan said she’d invited Tahoe Forest Hospital District’s (TFHD’s) CEO Harry Weiss to speak to the board about the “qualities and attributes” they should be looking for as they enter into another CEO search.

O’Flanagan worked under Weiss at Tahoe Forest Hospital for a year before she retired as HR director there. Weiss has been at the helm of TFHD, a much larger critical access hospital, for four years now. But, he has 42 years of experience in rural health care, he said.

Weiss noted that leading a rural, critical access hospital is much more difficult than working in a much larger hospital setting. This is because of the complexity of rules and regulations, and because a “stand alone” hospital doesn’t have the safety net that being part of a system of hospitals provides. That “brotherhood” of hospitals can help ensure that one of their members isn’t “falling off the train tracks,” he added.

He is vice president of the Association of California Hospital Districts (ACHD), and in his work advocating for rural hospital districts there, it has become even clearer to him how at risk small rural hospitals are, Weiss said. Since 2010, he noted, 102 district hospitals have closed.

That number, counting 2019 statistics, is now up to 119, with the largest number of closures, 18, occurring in the current year.

Weiss said he’d be happy to help consult with EPHC’s board as they go through their current recruiting effort, either by phone or in person to “whatever degree you want help.” Leading a critical access hospital, he said, “requires, with all due respect, experience, not just bright minds.”

“The previous CEO had energy, relative intelligence, but no experience,” vice chairman Swanson observed.

“As you found,” said Weiss, “[he had] high energy, but other shortcomings.” And, Weiss emphasized the importance of checking as large a list of references as possible from different groups, “so you can get a deep understanding. What’s their track record.”

Board Chairman Gail McGrath noted that in the CEO search concluded a year ago, “We didn’t have the perfect person. We took youth and energy, we really needed that … you never really know someone until you’ve lived with them and worked with them. Then, it all comes out. We need to be more careful. If we don’t see someone that fits, we don’t take them,” she said, adding, “We force Jayne [O’Flanagan] to keep on working.”

Weiss encouraged the board to collaborate with Tahoe Forest and other local hospitals, such as Plumas District Hospital, whose CEO, JoDee Tiddle, attended, at McGrath’s request. Working together, learning from each other’s experience, was very important, said Weiss.

Tiddle also emphasized the importance of collaboration and said she was looking forward to working more closely with EPHC in the future. “We’ve been working for years, from our standpoint” said McGrath, “to have better communication with both of you. With the prior CEOs in your institutions, that wasn’t possible. Hallelujah if that time has come.”

Weiss echoed O’Flanagan in promoting a sense of “urgency,” noting that, in rural hospitals that aren’t a part of a larger system, “well intentioned people get relaxed about operations or quality or patient satisfaction.” Further, he emphasized the importance of a set of “building blocks” that will make the organization “nimble, successful and stable.”

Swanson said, “Our organization might be lacking in those building blocks. What kind of candidate can lead in that situation?”

Weiss answered that the board should look for a good leader with critical access experience, which includes an understanding of quality measures, finances, legal requirements, and ideally someone who knows what’s going on in nursing and ancillary services.

In addition, the candidate should be someone who has demonstrated a readiness to “crack the whip in a nice way,” to create that sense of “urgency and structure.”

“We’ve increased the pace in our organization tenfold, “ Weiss added. “ We’re trying to play catch up. The world isn’t standing still.”

He also said they should look for someone who would stay for 10 years, so that progress made wouldn’t be lost. Given that the average tenure of a hospital CEO is approximately 3.5 years, however, that could be difficult.

Board Secretary Harvey West asked both Tiddle and Weiss if they thought a doctor could be a good candidate, or was that “too big a jump?” Tiddle said, “Yes … learning from the school of hard knocks,” could be beneficial. But, Weiss noted that would only work if the hospital already had certain building blocks in place, so that the CEO was stepping into an already smoothly running system. And, that is something the board and O’Flanagan had already said was lacking.

McGrath asked Weiss if the board could seek support from the Association of California Healthcare Districts. Weiss answered, “Yes, if there’s active attendance.” He strongly recommended that the board attend an upcoming leadership conference. “In order to move forward, you need to move forward at the governance level,” he said.

In addition, Weiss reminded the board, “You have one employee, which is the CEO,” noting their role is to oversee the “why, but not the how … Once you make that good choice of CEO, [you] let them sink or swim.”

Finally, Weiss offered to help EPHC by providing doctors from TFHD. He said, also, that “at least an informal” connection “between facilities would be really wise.” Though the board didn’t address this directly, Weiss’s comments could point to the possibility of a more formal connection between the two hospitals.

CNO recruitment

Donna Dorsey, who was previously ER manager and Penny Holland, previously acute care manager, have taken on CNO duties on an interim basis. Dorsey attended the meeting, and when asked for her assessment of how things were going, she said, “People are hanging in. There are a lot of things we need to catch up on that have been missing.”

These include addressing quality measures, among other things, Dorsey said. But, she added, “Things are going smoothly considering all the changes in the last weeks.”

McGrath asked her specifically about morale, and Dorsey answered, “We feel like, we were headed somewhere, where are we going now? We’ve gone back to things we used to do.”

Swanson asked for Dorsey’s perspective on what she’d like to see in a new CNO.

Referencing the most recently departed CNO, Dorsey said, “a lot of traits [she] had were great, but ideally they [the new CNO] would care a great deal about this community and be loyal to it … if that were their number one motive. Of course, we want to be viable and make money, but that needs to be in balance.”

In addition, Dorsey said, “There’s a fear of taking on that position — it feels cursed, because of so many changes.” She said that instead of looking for a “magic person,” she’d like to see “someone who can support us all and help us grow.”

Board chairperson comments

During board comments as the meeting wrapped up, Board Chairman Gail McGrath addressed staff members who were present and said, “Thank you all for hanging in for everything we’ve been through. It’s not the end of the world, just another day, and stuff happens. We appreciate it, and tell your departments that we’re pleased.”

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