Opening & Reports
1. The Consent Agenda was approved. It contained the Minutes for the August Board Meeting; Minutes for a Special Session by the Budget and Finance Subcommittee; and Minutes for a Community Relations Committee Meeting.
2. Dr. Seper, Hospital Chief of Staff, presented the applications for Medical Staff. Approved by the Board.
1. Future Workforce—Jeff Mutz, HR Director. CEO, Steve Underdahl, has been worrying for some time that the Pandemic changed the workforce available to the health care sector. This report was a first step at addressing the problem, starting with some data.
A. “Millennials have replaced Baby Boomers as the dominant workforce.”
1) Baby Boomers (born < 1965 –80 million) are only 16% of workforce.
2) Gen X (born 1965-1980—55 million) are 33% of workforce.
3) Millennials (Born 1981-1994—72 million) are 47% of workforce.
4) 47.4 million workers quit for better pay or better conditions during Pandemic.
5) 4.6 million workers exited the work force.
6) In 2021, the exit rate from the workforce was 14.3%; the new hire rate 9.8%.
B. Worker preferences and expectations have also changed.
1) Workers want fewer layers of bureaucracy; great autonomy on the job; at least some remote working time.
2) One “preferred” projection: 50% on site; 40% hybrid; 10% remote
3) Employees want an employer who is ethical, inclusive, open, concerned about their wellbeing; facilitates a work-life balance; and rewards accomplishments–not years on the job.
C. The information listed above suggest there are workforce problem facing healthcare.
1) Currently at NH&C: 90% of workforce is on site; 10% hybrid; < 1% remote.
2) Patients expect healthcare services to be delivered face-to-face.
3) Health care has many traditional hierarchies and established procedures.
D. The topic will be further explored at the next Board Retreat.
2. Water Tower Addition—David Bennett, City of Northfield Public Works. The City is projecting that the area around the hospital will be developed within the next 5 years. This will require upgrading the local water system, i.e., adding a water tower to raise the water pressure in the area. The project will also provide redundancy for the hospital water system. The City has a purchase agreement with St. Olaf College for 5 acres of land adjacent to the hospital site and located at the end of the hospital’s access road. The City was asking for use of the access road to do daily checks on the tower, maintenance, and construction. Construction time was estimated at about a year. Board members were concerned that the hospital’s access road could become a city street with an increase in traffic volume and noise. Some Board members expressed a desire to see a written document spelling out the proposed agreement, including items such as maintenance, before voting on the proposal. City officials (mayor and administrator) urged the Board to cooperate and vote now. A motion passed—details to be negotiated later?
3. Strategic Partnerships Framework—Steve Underdahl, CEO. Underdahl stated that partnerships and alliances are crucial if NH&C is to remain independent. The facility must be “independent but not isolated.” The topic of strategic partnerships is well established in the business literature. Successful alliances require trust, commitment, aligned missions and compatible operations. Underdahl recognized a need to develop a rigorous and standardized process for NH&C to form alliances. The process will continue.
Executive and Committee Reports
1. CEO Report—Steve Underdahl, CEO. a) COVID: the hospitalization rate has fallen to 0-2 patients per day. b) Strategic: The recently implemented Electronic Health Record System (EHR) is maturing. The staff are solving problems and creating programs to better utilize the system. The Urgent Care Center is up and operating, and busy on the first day. The midwife program is now fully staffed and seeing patients. c) operations: patient volumes are high, but the payer mix is poor; i.e. a high proportion of Medicare and Medicaid patients which don’t pay as well as patients with private insurance such as BlueCross/Blue Shield. The hospital received a check for $78,000 for their share of the savings realized by their Accountable Care Organization (ACO). The nursing strike in the Twin Cities made it difficult to transfer patients needing more care. Some patients were relocated to places as distant as Duluth and Cedar Rapids. Underdahl expressed his hope for another strong fourth quarter to move the facility toward breakeven. Typically the fourth quarter is strong because insured patients have met their deductibles for the year, and can now schedule elective procedures. Underdahl also expressed a hope that some of the large employers in the region would redefine their insurance year, e.g. from Jan. 1 –Dec. 31 to something like April 1 to March 31. This would help spread out the patient volume at the hospital.
2. Financial Report—Scott Edin, CFO. (No financial tables were distributed to the Board. Changing EHR systems means that staff must learn new billing codes, procedures, etc. so revenue lags for a few months.) Inpatient volume has been strong, but clinic volume lagged due to closure for a week while the new EHR system was installed. Expenses have been rising. Edin forecast a deficit in the Net Operating Income, year to date, of -$6.4 million. While the deficit is a concern, Underdahl cautioned against “trying to fix everything until you know the problem.” i..e., wait until we have accurate revenue data.
3. Quality Committee Report—Sarah Carlsen. NH&C had high scores on their ACO metrics and no penalties assessed.
A group of employees and Board members made a trip to Winona to learn about their program to promote Social Determinants of Health after learning about the program at a national convention. People were impressed with Winona’s program.
Meeting adjourned at 7:42 p.m.
Next Meeting: Oct. 27.