NEIGHBORS HELPING NEIGHBORS: A PARTNERSHIP FOR THE REVIVAL OF THE TRUE COMMUNITY HOSPITAL

A Proposal for the Collaboration between HCH and UAB

Hale County Hospital Background Hospital is typical of many small rural community hospitals

across state 39 bed, County Hospital with average daily census of 6

patients Founded by Hill Burton Act in 1960’s 1 Internist, 1 Emergency Medicine, and 1 Family Medicine

Doctor Only 1 doctor lives in the Greensboro Community

Hale County Hospital has struggled with low census, high physician and medical staff turnover, and lack of strategic mission and vision

Struggles are similar to many other small and rural community hospitals

Coming changes in healthcare present threat to survival of HCH and threat of loss of role of small and rural community hospitals in communities and in healthcare system across the state

Hale County Hospital

Loss would mean loss of critical institution in the community (see Marion, Alabama).

Loss would hurt health and quality of life of its citizens (difficulty recruiting physicians, nurses, loss of access).

To survive and thrive hospital is going to need to identify and pursue vision and mission that clearly articulates reason for being and draws on and builds around local strengths and values

Greensboro Community Strengths Complex and Rich Culture and History which

continues to impact community life today Strong religious values and deep tradition of

Neighbors Helping Neighbors Values Grounded in Human Relationships Because of these values, individuals,

Churches, and other civic organizations play a central role in supporting vulnerable members of the community and people in need.

Other Community Efforts

In addition, a number of community oriented initiatives have sprouted in various fields: Auburn University Rural Studio

(Architecture) HERO (Housing and Social Services) Teach For America (Education) Project Horseshoe Farm (Community Health

Leadership)

Potential Role for Hale County Hospital As a natural institutional anchor of the

community, hospital has strong potential to build on existing community efforts and become a natural hub and coalescing force for many of the community activities and initiatives.

Success in this role could strengthen and provide basis for growth for the hospital and have strong positive ripple effect throughout the community.

How Can this be Done?

Recently HCH hospital has hired Michael Lynch to work with hospital and Board to help with program development and development of strategic mission and vision including pursuing a mutually beneficial relationship with UAB

Successful relationship will require institutional commitment and effective champions from HCH and UAB

Partnership between HCH and UAB could occur on 3 levels, each of which supports and reinforces the others: Clinical Services Education and Training Administrative/Leadership

UAB and HCH: Clinical Services “Primary Care Plus”

Emphasis on top notch primary care in Hale County with consultation and support from specialists and technical expertise via telemedicine from UAB to give accessible, high quality, cost effective care in local community (see ECHO program in New Mexico).

Weds clinical strengths of HCH (local personalized care, knowledge of patients and community, local community partnerships) with strengths of UAB (specialized expertise, advanced technologies, access to resources, political influence)

Model Improves Cost, Quality, and Access

Keep people local and avoid unnecessary referral to high tech, high cost centers (quality, cost control, access)

Improved coordination of care via PCP who knows patient, knows community resources, and can integrate care (quality, cost control, access).

Overcomes transportation issues which are even more difficult for indigent and rural patients (access).

Over time, this model strengthens local primary care capacity through ongoing real time continuing medical education (quality, cost control, access)

Eases burden on larger hospitals and systems by avoiding unnecessary referrals allowing larger hospitals to focus on patients who most need their care (access).

Strengthens pipeline of top notch PCP’s who want to live and work in rural community (access, quality).

UAB and HCH: Education

Goal is to develop unique community based training site for primary care physicians, nurses, and other health providers

Program is dedicated to developing community based service leaders in rural and other communities.

Training model emphasizes distinctions and advantages of community oriented and more personal care and practice.

Model also emphasizes role of physician, nurse, etc as local citizen and contributor to the community.

How can this be done?

Take steps towards creating community health leaders track for physicians, nurses, and other health professionals.

1st step is to develop elective fourth year rotation for medical students who would spend 5-6 months living and completing clinical rotations in Greensboro (TERM, Scholarly Activity, Community Medicine Electives, Primary Care Electives, Psychiatry/Behavioral Health Elective, etc).

Track would be available to all students interested in community oriented medicine including those in the Rural Scholars programs.

Over time as capacity is built, track could be expanded in length and to include family practice residents and students from other disciplines.

Curriculum Design – Part I

60% of student time is spent in clinical settings (hospitals, clinics, etc)

40% of time spent learning about effective community involvement and engagement, working in and learning about community and initiatives (schools, churches, civic organizations, non-profit organizations), learning about hospital and non-profit leadership and administration, and learning about health care systems issues.

Curriculum Design – Part II

Complementing reading and discussion series focusing on topics including: Effective work within a community Effective management and leadership Understanding health care systems including

introduction to structure and financing of healthcare system

healthcare law and ethics healthcare economics history and evolution of healthcare system health policy

UAB and HCH: Administrative/Leadership Need Effective Administrative Champions on

both ends for partnership to work HCH offers understanding of local politics, local

culture and values, established relations with and support of local community, and support of hospital and board.

UAB offers expertise and resources of larger system to offer administrative support, especially in areas where large size imperative for success: Information technology, telemed, billing, finances,

legal, legislative, and other consultative help Important that UAB supports but does not replace

people providing local administrative functions

Benefits to Hale County Hospital and Community Enhanced Pipeline for recruitment and retention of MD’s to

live and work in the Greensboro community Build culture of clinical and training excellence Access to specialized expertise in clinical care while staying

close to home Opportunity to innovate and develop new service and

educational programs that have potential to improve local care and garner significant philanthropic and government financial support

Strengthen relationship and trust with community and potential for hospital to become community hub that helps to integrate community activities and to strengthen broader community.

Political, financial, and administrative backing and support from UAB

By far the best chance for the Hospital to survive, thrive, and grow

Benefits For Alabama

Potential Model for communities throughout the state

Creates pipeline of leaders who can carry this plan out

Capacity to distribute specialized care and knowledge that us meaningfully integrated to help people in local community, many of whom would otherwise have no access

UAB would not replace but rather support HCH Administration and staff

Benefits to UAB and Alabama Gives UAB another distinctive signature clinical and

educational program that: Has established community roots that would otherwise

be very difficult and take many years to create Builds upon and strengthens UAB mission of improving

rural healthcare and bolsters pipeline of rural physicians and healthcare providers.

Provides model for survival and strengthening of small community hospitals across state.

Creates pipeline of community health leaders who have capacity to help implement plans to strengthen local health systems and communities across the state.

Provides opportunity for potentially important research in health services and educational programs.

Has strong potential to attract philanthropic and government support

Additional Benefits to UAB

Strengthens and expands UAB community and rural health educational offerings

Has strong potential to draw even larger number and broader range of top students to rural and primary care and community health fields

Creates another competitive advantage in attracting even more top applicants to UAB educational programs

Synthesizes several UAB educational initiatives and goals into a single comprehensive educational experience/track