Northfield Hospital Board Report: August 2018


  1. Chair, Charlie Mandile, called the meeting to order at 6:35 p.m. The Agenda was approved.

The Consent Agenda was approved.  The Consent Agenda included Minutes for the July Board Meeting, Minutes for a Governance and Planning Committee Meeting, and Minutes for a Special Governance and Planning Committee Meeting.

The proposed revisions to the Foundation Bylaws were removed from the Consent Agenda and discussed by the Board.  The provisions for Foundation Board members were clarified.  The Revisions will come to the Board in Sept. for a vote.



  1. Hospital Chief of Staff—Randy Reister. No report, but Reister asked Board members what information they would like him to bring to them at future meetings.  The Board members didn’t offer any specifics, but asked to be kept informed of the concerns from the medical staff.  A Board member inquired about Board-staff interactions: where and when did that happen?  CEO Underdahl responded that Board involvement at scheduled staff events was appreciated, and Board members can request to visit specific departments. Concerns were voiced about the appropriate level of Board-Staff interaction; where should the line be drawn? The applications for Medical Staff Membership/Privileges were presented to the Board.  The Board approved the applications.
  2. Chief Medical Officer—Jeff Meland. The Minnesota Hospital Association is reissuing their survey of factors leading to “burnout” of medical providers. Meland cited several steps that NH&C had taken to improve conditions for MDs since last year’s survey, and hoped that last year’s good showing would be improved.


Presentations/Discussions/Action Items

  1. ENT Sinus Navigation System—Tammy Hayes. Hayes made the first presentation of a proposal to purchase an ENT Sinus Navigation System. NH&C is now renting the equipment each time a surgery is scheduled.  The cost last year was $81,000 for 32 surgeries.  The cost of the desired system is $155,424 plus $300 per patient for disposables.  Some of the rent currently being paid could go towards the purchase price.  The equipment has a 2-year payback period, and an anticipated technical life of 5 years.  Only one provider at NH&C is currently using the system, but the services of an ENT are essential for the hospital and sinus navigation systems are the standard of care.  This item was not included in the 2018 capital budget.  The proposal will be voted upon at the Sept. Board meeting.
  2. Nursing Patient Care Update for the LTCC—Tammy Hayes. The Center for Medicare and Medicaid mandates an annual survey of patient care in all long term care centers (LTCC) in the US.  An outside agency interviews each patient and the patient’s family. The results for all LTCCs are posted online (Nursing Homes Compare).    The LTCC at the hospital continued to earn a 5-star rating, the highest.  Hayes said that it is growing increasingly difficult to staff the LTCC with LPNs, as a higher percentage of persons entering nurses training are continuing on to earn a RN.  Also, the Mayo System has started hiring LPNs.  The Board said it would be helpful to see the survey results for NH&C in comparison to other LTCC providers in the region.


Executive and Committee Reports

  1. CEO Report—Steve Underdahl. Work and progress continues on a wide variety of projects.  a) NH&C continues to study the options for electronic health records (EHR). This has been a lengthy process, but it is imperative to “get it right”.  b) The Administration is revisiting the master plan for Obstetric services, to determine the amount it can afford to spend on improvements. c) Work continues on improving cyber security.  Medical facilities are prime targets for ransomware.  Carleton and St. Olaf Colleges have jointly hired a full-time person to work on cyber security.  The hospital IT will dialogue with the cyber expert to see if there are shared problems.  d) An assessment of customer-facing-technology is underway.  United Health Care in the Cities is pushing forward on this.  A recent study suggests that 74% of Millennials would prefer a virtual visit with an MD rather than an office visit.  e) Construction is underway on the Senior Care building.  A lot of dirt is being moved. f) NH&C is expecting to receive about $90,000 back from the Medicare Value Based Purchasing  program that punishes or rewards hospitals for providing high quality care.  g) Underdahl is working on a “white paper” regarding the funding of PERA by municipally owned hospitals.  h) The meetings of the City/Hospital Governance Team have been going well.  David Koenig volunteered his services to facilitate the process.  i) The Express Care Clinic has not been “as busy as we would like,” in part due to the closing of the street in front of the clinic, but this has provided time to solve problems prior to flu season.
  2. Financial Report—Steve Underdahl. There was a Net Operating Loss of $58,000 for July, but that was $269,000 better than budgeted. It was a relatively good month financially.  August looks to be a very good month financially.  Cash on Hand (COH) remained at 236 days.  A Board member asked if this was “too much cash?” The short answer was that there is no such thing as “too much cash,” and “COH is a metric not a bucket.” The cash actually sits in many different accounts.  A question was raised concerning a long-term capital budget. Yes, the budget exists and is voted by the Board for each budget year, but it is seldom referenced, except when purchases have not been included in the budget, as is the case for the ENT Sinus Navigation System.
  3. Strategic Discussion: Now/Near/Far Method—Steve Underdahl. Underdahl shared his thoughts on strategic planning which must simultaneously focus on 3 timelines: now, near, and far. Current problems typically receive the most attention, but it is important to understand how current plans are consistent with next year’s production and lead into future strategies.  How does one organize a management team and a board to facilitate simultaneous 3-stage planning?  Success now does not guarantee future survival of the institution, especially in a world with lengthy development cycles.  Ford Motor Company was cited as an example of a firm with a disconnect between the “now” and the “far”.  Comments were that institutions need a “safe place to dream”; small firms should plan to be “the second wave to hit the beach” if they hope to survive; the clinic strategy of NH&C some years ago was a great example of a “near” action consistent with a “far” objective.  This is material for a future strategic planning retreat.
  4. Community Relations Committee—CC Linstroth. The committee is working on a job description and calendar. The planned activities tie into many of the hospital’s strategic plans.  Candidate Tina Smith’s staff will be in Northfield on Friday, Sept. 7thto discuss affordable, accessible, health care.  Board members were urged to attend.



Northwest Area Process Advisory Committee—Fred Rogers.  City Mayor, Pownell appointed the committee to study land use and zoning in the area near the hospital.  Pownell’s objective was to foster new growth in Northfield and to increase the tax base, i.e. promote commercial and industrial development.  This is a problem as currently the workforce available in the area is not sufficient to support another large employer, and there is a lack of affordable housing for workers earning factory/retail wages.  The Committee recommended that the City start with a small plot (80 acres) and see if the landowners and neighbors are supportive of the effort.

Meeting adjourned at 9:20 p.m.

Next meeting:  Sept. 27, 2018

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