IMPLEMENTATION PLAN Addressing Community Health Needs Marias Medical Center ~ Shelby, Montana 1
Table of Contents The Implementation Planning Process... 3 Prioritizing the Community Health Needs... 5 Marias Medical Center s Existing Presence in the Community... 5 List of Available Community Partnerships and Facility Resources to Address Needs... 5 Toole County Indicators... 7 Public Health and Underserved Populations Consultation Summaries... 8 Needs Identified and Prioritized... 9 Prioritized Needs to Address... 9 Needs Unable to Address... 10 Executive Summary... 11 Implementation Plan Grid... 13 Needs Not Addressed and Justification... 24 Dissemination of Needs Assessment... 25 2
The Implementation Planning Process The implementation planning committee comprised of Marias Medical Center s leadership team and board members participated in an implementation planning process to systematically and thoughtfully respond to all issues and opportunities identified through the Community Health Services Development (CHSD) needs assessment process, a part of the Frontier Better Medicine Better Health Partnership (FMBHP) project. The facility conducted the CHSD process in conjunction with the Montana Office of Rural Health (MORH). The CHSD community health needs assessment was performed in the spring of 2014 to determine the most important health needs and opportunities for Toole County, Montana. Needs were identified as the top issues or opportunities rated by respondents during the CHSD survey process or during focus groups (see page 9 for a list of Needs Identified and Prioritized ). For more information regarding the needs identified, as well as the assessment process/approach/methodology, please refer to the facility s assessment report, which is posted on the facility s website (mmcmt.org). The implementation planning committee identified the most important health needs to be addressed by reviewing the CHNA, secondary data, community demographics, and input from representatives representing the broad interest of the community, including those with public health expertise (see page 8 for additional information regarding input received from community representatives). The implementation planning committee determined which needs or opportunities could be addressed considering Marias Medical Center s parameters of resources and limitations. The committee then prioritized the needs/opportunities using the additional parameters of the organizational vision, mission, and values, as well as existing and potential community partners. Participants then created a goal to achieve through strategies and activities, as well as the general approach to meeting the stated goal (i.e. staff member responsibilities, timeline, potential community partners, anticipated impact(s), and performance/evaluation measures). The prioritized health needs as determined through the assessment process and which the facility will be addressing relates to the following healthcare issues: 1. Awareness of services and access to care 2. Quality of care provided 3. Preventative health and health education 4. Visiting specialists and telemedicine 3
In addressing the aforementioned issues, Marias Medical Center seeks to: a) Improve access to healthcare services; b) Enhance the health of the community; c) Advance medical or health knowledge; d) Relieve or reduce the burden of government or other community efforts Marias Medical Center s Mission: Marias Medical Center will be the leader in providing primary, long-term care, assisted living and select specialty care to the people in north central Montana. We will set the standard for quality and technology in our service area and continue to develop new services to meet the needs of all people in the communities we serve. Marias Medical Center s Vision: Marias Medical Center is dedicated to being a leader in providing and promoting health and wellness to Shelby and the surrounding area. Implementation Planning Committee Members: Bill Hartley Interim CEO, Marias Medical Center Jessica Brusven Foundation Director, Marketing Director/Better Health Improvement Specialist, Marias Medical Center Jamie Brownell CEO, Marias Healthcare Services, Inc. Renee last name Medical Staff Coordinator, Marias Medical Center Tamara last name position, Marias Medical Center Barb Cole Board member, Marias Medical Center Deb Brandon Toole County Commissioner 4
Prioritizing the Community Health Needs The implementation planning committee completed the following to prioritize the community health needs: Reviewed the facility s presence in the community (i.e. activities already being done to address community need) Considered organizations outside of the facility which may serve as collaborators in executing the facility s implementation plan Assessed the health indicators of the community through available secondary data Evaluated the feedback received from consultations with those representing the community s interests, including public health Marias Medical Center s Existing Presence in the Community Marias Medical Center (MMC) participates in the Hill-Burton program that provides financial assistance with medical bills for community members who qualify. MMC s annual health fair provides health information and health screenings at a reduced cost to community members. MMC provides My Portal, an online program that allows patients to view their medical records, communicate with nurses, and pay medical bills. MMC s Mental Health Advisory Committee will host a public speaker to address suicide prevention in November 2014. An Emergency Medical Service (EMS) community class will be offered at MMC in the winter of 2014. Dr. Hardy will leach nutrition classes for community members beginning in the fall 2014. Jessica, please list and describe any other activities your facility performs in the community as well as any existing community benefit activities beyond charity care programs. Examples may include: health fairs, wellness programs, education classes, sponsorships of community activities, etc. List of Available Community Partnerships and Facility Resources to Address Needs Bountiful Baskets help provide fresh, nutritious food to the community. The Shelby Promoter publishes local newspaper announcements about MMC services and events. Marias Heritage Center and Marias Extended Care Center provide residential services to senior citizens in Shelby and surrounding communities. Shelby Civic Center provides what? Anything specific? The Shelby Senior Center sponsors a caregiver relief program for individuals providing full-time assistance to others. 5
This, That, and the Other (TTO) radio announcements provide information about current events through the local KSEN/K96 radio station. Toole County Public Health Department works toward the promotion and maintenance of individual, group, and community health. MMC partners with Toole County Public Schools to advertise hospital services during halftime of sporting events. Jessica, please list any other organizations of existing or potential partnerships 6
Toole County Indicators Low Income Persons 12% of persons are below the federal poverty level Uninsured Persons 17.3% of adults less than age 65 are uninsured Data is not available by county (data is available for some counties) for uninsured children less than age 18 Leading Causes of Death: Primary and Chronic Diseases Heart Disease Cancer Chronic Lower Respiratory Disease * Note: Other primary and chronic disease data is by region and thus difficult to decipher community need. Elderly Populations 16% of Toole County s Population is 65 years and older Size of County and Remoteness 5,141 people in Toole County 2.7 people per square mile Nearest Major Hospital Benefis Hospital in Great Falls, MT is 90.9 miles from Marias Medical Center 7
Public Health and Underserved Populations Consultation Summaries Public Health Consultation [January 28, 2014] Kristi Aklestad RN, Toole County Health Department Rikki James Montana Tobacco Use Prevention Program/ Clean Indoor Air Act Coordinator, Toole County Health Department Toni Moberly RN/ Montana Cancer Control Program, Toole County Health Department Look at Benefis community health needs assessment survey data Many people don t know what services the health department offers Have other questions they would like to include in the survey (referred to as Appendix B) Underserved Population Low-income/Underinsured [January 28, 2014] Kristi Aklestad RN, Toole County Health Department Healthy Montana Kids Plus is different than Healthy Montana Kids People use both options in this area Healthy Montana Kids is like Medicaid for kids Underserved Population Senior Citizens [January 28, 2014] Brenda Gilmore Social Services, Marias Medical Center There is a need for senior wellness checks Underserved Population Youth [January 28, 2014] Peggy Taylor Principal, Shelby Elementary School Vicky Warila Youth Dynamics Leorra Nickol Youth Dynamics Schools have been trying to provide more suicide prevention information Prenatal, birthing, and breastfeeding classes would be beneficial to have in Shelby Underserved Population Tribal/American Indian [January 28, 2014] Marias Medical Center can accept Indian Health Services (IHS) patients if they are referred. 8
Needs Identified and Prioritized Prioritized Needs to Address 1. More than half (56.2%) of survey participants indicated that access to healthcare and other services was the most important component of a healthy community. 2. 36.5% of respondents indicated that they or a member of their household delayed getting healthcare services when they needed it. Of those, 25.8% delayed care because they don t like doctors, 21% indicated it took long to wait for an appointment, and 19.4% could not get an appointment. 3. 41.6% of survey respondents indicated improved quality of care would most improve access to healthcare. 4. Focus group participants perceived the hospital board could improve communication between community members and the hospital. 5. Survey respondents reported interest in attending classes regarding weight loss (30.3%), health and wellness programs (28.1%), women s health classes (22.7%), and nutrition classes (22.2%). 6. Focus group participants indicated that promoting preventative care would improve the health of the community. 7. 33% of respondents reported obesity/poor nutrition as a top health concern within the community. 8. Focus group participants mentioned they would like Marias Medical Center to host a health fair again. 9. A desire for senior well checks was indicated by 22.2% of survey respondents. 10. Healthy behaviors and lifestyles was indicated by 29.7% of survey respondents as a component of a healthy community. 11. 30.8% of survey respondents reported that more specialists would improve the community s access to healthcare. 12. 31.4% of respondents reported that cancer is a top health concern within the community. 13. 18.4% of survey respondents desired local podiatry services. 14. 13.5% of respondents reported experiencing periods of feeling depressed on most days for at least three consecutive months. 15. According to the data from MT DPHHS, Toole County has a suicide rate of 27.2 per 100,000 people compared to Montana s rate (20.3 per 100,000) and the nation s rate (12 per 100,000). 16. 26.5% of respondents indicated a need for local dermatology services. 17. Respondents (17.8%) expressed interest in chronic pain management classes and 16.8% desired a chronic pain specialist. 18. 10.3% of respondents indicated a desire for pulmonary/cardiac rehabilitation services. 9
Needs Unable to Address (See page 24 for additional information) 1. 51.9% of respondents indicated alcohol/substance abuse was a top community health concern. 2. 17.9% of respondents indicated that costs of prescriptions prohibited them from getting a prescription or taking their medication regularly. 3. More than half (57.8%) of respondents indicated that more primary care providers would improve the community s access to healthcare. 4. 30.5% of respondents indicated they were not aware or were unsure of programs that help people pay for their healthcare bills. 5. Focus group respondents indicated a need for local home health services. 10
Executive Summary The following summary briefly represents the goals and corresponding strategies and activities which the facility will execute to address the prioritized health needs (from page 9). For more details regarding the approach and performance measures for each goal, please refer to the Implementation Plan Grid section, which begins on page 13. Goal 1: Please Note: The executive summary will be filled-in by Montana Office of Rural Health staff once the grid is complete on the subsequent pages Strategy 1.1: Activities: Strategy 1.2: Activities:. Goal 2:. Strategy 2.1: Activities: Strategy 2.2: Activities: 11
Goal 3:. Strategy 3.1: Activities: Strategy 3.2: Activities: 12
Implementation Plan Grid Goal 1: Improve awareness of local healthcare services to enhance the community s access to care. Strategy 1.1: Promote Marias Medical Center services to the community. Activities Responsibility Timeline Promote the services offered at Marias Medical Center by advertising via newsletter announcements, internet postings, newspaper ads, and radio announcements. Create a weekly newspaper excerpt from Marias Medical Center providers to announce new personnel, new service offerings, and other hospital announcements. Use TTO (This, That, and the Other) radio announcements from doctors to notify listeners of the services provided at Marias Medical Center. Marketing Director MMC Providers MMC Providers Final Approval Partners 13 CEO Marketing Director Marketing Director Shelby Promoter, KSEN/K96, any other partners? Shelby Promoter KSEN/K96 Potential Barriers Needs Being Addressed by this Strategy: #1: More than half (56.2%) of survey participants indicated that access to healthcare and other services was the most important component of a healthy community. #2: 36.5% of respondents indicated that they or a member of their household delayed getting healthcare services when they needed it. Of those, 25.8% delayed care because they don t like doctors, 21% indicated it took long to wait for an appointment, and 19.4% could not get an appointment. Anticipated Impact(s) of these Activities: Increased community awareness of services available at MMC Increased utilization of local services Fewer community members leave the local community for needed healthcare services Customers experience higher satisfaction with local services Strategy 1.1 continued on following page
Strategy 1.1 continued Plan to Evaluate Anticipated Impact(s) of these Activities: Distribute patient satisfaction surveys to measure quality of care, effectiveness, and satisfaction with availability of appointments Measure of Success: MMC improves patient satisfaction as measured by the surveys by X% by MM YYYY. 14
Goal 2: Improve the quality of care provided at Marias Medical Center. Strategy 2.1: Create an internal communications plan for Marias Medical Center. Activities Responsibility Timeline Create informative memos for staff and display them on tables in break rooms. Create phone scripts for administrative staff to use to improve customer experience and customer satisfaction. Encourage staff to set the Intranet portal as their homepage on their computer. Hold a collaborative Annual Planning Meeting for Marias Medical Center and Marias Healthcare Services, Inc. Based on the Annual Plan, each department will list their specific responsibilities to help achieve the facility s annual goals. Provide training to all employees to define expected compliance of the Code of Conduct and Discrimination policies. Include Marias Medical Center s vision and Who? Final Approval Will report to who? Who? CEO Who? MMC CEO & Marias Healthcare Services CEO Department Heads Will report to who? Partners 15 Board Board CEO Board Director of Marketing CEO Marias Healthcare Services, Inc. Who will perform the training? Potential Barriers mission statements on all documents. Needs Being Addressed by this Strategy: #1: More than half (56.2%) of survey participants indicated that access to healthcare and other services was the most important component of a healthy community. #2: 36.5% of respondents indicated that they or a member of their household delayed getting healthcare services when they needed it. Of those, 25.8% delayed care because they don t like doctors, 21% indicated it took long to wait for an appointment, and 19.4% could not get an appointment. Strategy 2.1 continued on following page
Strategy 2.1 continued #3: 41.6% of survey respondents indicated improved quality of care would most improve access to healthcare. #4: Focus group participants perceived the hospital board could improve communication between community members and the hospital. Anticipated Impact(s) of these Activities: Higher employee satisfaction and awareness of organizational goals. Plan to Evaluate Anticipated Impact(s) of these Activities: Regularly check-in with departments to give progress updates for the goals included in the Annual Plan. Measure of Success: MMC and Marias Healthcare Services create a collaborative Annual Strategic Plan by MM YYYY. 16
Goal 2: Improve the quality of care provided at Marias Medical Center. Strategy 2.2: Encourage employee engagement at Marias Medical Center. Activities Responsibility Timeline Plan department head meetings immediately following board meetings to share information with MMC staff. Take minutes and record attendees at department meetings so ideas and concerns are shared. Engage and motivate staff through a workshop lead by Karen McNenny. Explore possible continuing education opportunities for staff, especially Human Resources. Department Heads Department Heads Final Approval Board Board Partners Who? Board Karen McNenny Who? Will report to who? Any partners? Potential Barriers Needs Being Addressed by this Strategy: #1: More than half (56.2%) of survey participants indicated that access to healthcare and other services was the most important component of a healthy community. #2: 36.5% of respondents indicated that they or a member of their household delayed getting healthcare services when they needed it. Of those, 25.8% delayed care because they don t like doctors, 21% indicated it took long to wait for an appointment, and 19.4% could not get an appointment. #3: 41.6% of survey respondents indicated improved quality of care would most improve access to healthcare. Anticipated Impact(s) of these Activities: Higher employee satisfaction and awareness of organizational goals. Plan to Evaluate Anticipated Impact(s) of these Activities: Employees rate the overall effectiveness of Karen McNenny s staff engagement workshop. Measure of Success: MMC contracts with Karen McNenny to host a staff engagement and leadership workshop in MM YYYY and X% of employees indicate satisfaction with the staff engagement workshop. 17
Goal 3: Increase opportunities for health education and prevention in Toole County. Strategy 3.1: Provide a variety of health education classes for community members. Activities Responsibility Timeline Identify interested hospital staff and community leaders who are willing to share their knowledge about specific health topics with community members. Teach preventative health classes (how often?) for community members on a variety of top rated health topics (e.g. healthy weight, diabetes education). Dr. Hardy will lead nutrition classes (how Who? MMC Staff & Community Leaders/ Experts Final Approval Marketing Director Partners List potential class leaders Board Any partners? Dr. Hardy Board Any partners? Potential Barriers often?) for community members. Needs Being Addressed by this Strategy: #1: More than half (56.2%) of survey participants indicated that access to healthcare and other services was the most important component of a healthy community. #5: Survey respondents reported interest in attending classes regarding weight loss (30.3%), health and wellness programs (28.1%), women s health classes (22.7%), and nutrition classes (22.2%). #6: Focus group participants indicated that promoting preventative care would improve the health of the community. #7: 33% of respondents reported obesity/poor nutrition as a top health concern within the community. Anticipated Impact(s) of these Activities: More opportunities for community members to learn about health topics Increased community participation in health activities Increase in healthy behaviors and lifestyles Increased awareness of chronic health conditions in the community Plan to Evaluate Anticipated Impact(s) of these Activities: Record the number of participants who attend each class. Gather feedback from participants about the effectiveness of the free health education classes. Measure of Success: MMC provides free monthly health education classes to the community. 18
Goal 3: Increase opportunities for health education and prevention in Toole County. Strategy 3.2: Hold a health fair in the community. Activities Responsibility Timeline Form a committee to plan the health fair. Create flyers/announcements to advertise the health fair to hospital staff and community members. Identify volunteers to discuss senior wellness classes (e.g. fall risks, bone density screenings, home checks, and osteoporosis). Include preventative health screenings at the health fair. Marketing Director Marketing Director Who? Toole County Health Department? Marketing Director Final Approval Partners 19 Board Will report to who? Will report to who? Will report to who? Who will serve on the committee? Shelby Promoter, KSEN/K96 Any partners? Toole County Health Department Potential Barriers Promote the new health education classes at Will report to MMC during the health fair. who? Engage school staff and involve students by Marketing Shelby Public advertising the health fair during halftime of CEO Director Schools school sporting events. Provide a personalized information log for each patient and offer yearly comparisons of Clinic Will report to health fair results to compare their health Services? who? status from year to year. Needs Being Addressed by this Strategy: #1: More than half (56.2%) of survey participants indicated that access to healthcare and other services was the most important component of a healthy community. #5: Survey respondents reported interest in attending classes regarding weight loss (30.3%), health and wellness programs (28.1%), women s health classes (22.7%), and nutrition classes (22.2%). Strategy 3.2 continued on following page
Strategy 3.2 continued #6: Focus group participants indicated that promoting preventative care would improve the health of the community. #8: Focus group participants mentioned they would like Marias Medical Center to host a health fair again. #9: A desire for senior well checks was indicated by 22.2% of survey respondents. #10: Healthy behaviors and lifestyles was indicated by 29.7% of survey respondents as a component of a healthy community. Anticipated Impact(s) of these Activities: Improved awareness of services available at Marias Medical Center, Marias Healthcare Services, Inc., and the Toole County Health Department Increased early detection and preventative treatment efforts Plan to Evaluate Anticipated Impact(s) of these Activities: Track the number of attendees at the health fair. Document the number of screenings provided to community members. Track the number of participants who have attended more than one health fair and utilize the yearly health comparison log. Measure of Success: Marias Medical Center organizes and holds a health fair in MM YYYY for at least X community members. 20
Goal 4: Improve access to specialty services through visiting specialists and telemedicine. Strategy 4.1: Promote telemedicine services at the clinic. Activities Responsibility Timeline Promote the use of telemedicine through patient testimonials. Inform staff about the services that are available through telemedicine so they can help refer patients. Host an open house to educate the community Marias Healthcare Services CEO Marias Healthcare Services CEO Final Approval Partners Board Any partners? Board Any partners? Who? Who? Any partners? Potential Barriers about telemedicine services. Needs Being Addressed by this Strategy: #1: More than half (56.2%) of survey participants indicated that access to healthcare and other services was the most important component of a healthy community. #11: 30.8% of survey respondents reported that more specialists would improve the community s access to healthcare. Anticipated Impact(s) of these Activities: Increased local access to healthcare services Fewer community members leave the local community for needed healthcare services Increased awareness of telemedicine specialty services offered at MMC Plan to Evaluate Anticipated Impact(s) of these Activities: Track the utilization of existing telemedicine services. Track the number of new patient referrals to telemedicine. Measure of Success: MMC serves X patients through telemedicine by MM YYYY. 21
Goal 4: Improve access to specialty services through visiting specialists and telemedicine. Strategy 4.2: Increase availability of select specialty services. Activities Responsibility Timeline Promote the specialty services that are currently available at Marias Medical Center through radio and in the newspaper. Provide visiting oncologist services. Provide visiting podiatry in the clinic. Provide mental health counseling via telemedicine. Begin recruiting for the following visiting specialties: chronic pain management, dermatology, pulmonary and cardiac rehab. Marketing Director Marias Healthcare Services CEO Marias Healthcare Services CEO Marias Healthcare Services CEO Human Resources September 2014 September 2014 Final Approval Partners 22 CEO Board Board Shelby Promoter, KSEN/K96 Any partners? Any partners? Board Any partners? Board Any partners? Potential Barriers Needs Being Addressed by this Strategy: #1: More than half (56.2%) of survey participants indicated that access to healthcare and other services was the most important component of a healthy community. #11: 30.8% of survey respondents reported that more specialists would improve the community s access to healthcare. #12: 31.4% of respondents reported that cancer is a top health concern within the community. #13: 18.4% of survey respondents desired local podiatry services. #14: 13.5% of respondents reported experiencing periods of feeling depressed on most days for at least three consecutive months. #15: According to the data from MT DPHHS, Toole County has a suicide rate of 27.2 per 100,000 people compared to Montana s rate (20.3 per 100,000) and the nation s rate (12 per 100,000). #16: 26.5% of respondents indicated a need for local dermatology services. Strategy 4.2 continued on following page
Strategy 4.2 continued #17: Respondents (17.8%) expressed interest in chronic pain management classes and 16.8% desired a chronic pain specialist. #18:10.3% of respondents indicated a desire for pulmonary/cardiac rehabilitation services. Anticipated Impact(s) of these Activities: Improved access to specialty healthcare services Improved awareness of available specialty services at MMC and Marias Healthcare Services, Inc. Increased utilization of local services Fewer community members leave the local community for needed healthcare services Plan to Evaluate Anticipated Impact(s) of these Activities: Track the number of people that utilize the various specialists available at MMC. Measure of Success: MMC recruits # new visiting specialists by MM YYYY. 23
Needs Not Addressed and Justification Identified health needs unable to address by Marias Medical Center 1. 51.9% of respondents indicated alcohol/substance abuse was a top community health concern. 2. 17.9% of respondents indicated that costs of prescriptions prohibited them from getting a prescription or taking their medication regularly. 3. More than half (57.8%) of respondents indicated that more primary care providers would improve the community s access to healthcare. 4. 30.5% of respondents indicated they were not aware or were unsure of programs that help people pay for their healthcare bills. 5. Focus group respondents indicated a need for local home health services. Rationale A focus on alcohol and substance abuse is currently beyond the capacity of the hospital and other community resources are better-suited to address these issues at this time. However, as indicated in Strategy 3.2, MMC is planning to provide mental health counseling via telemedicine by MM/DD. Controlling the cost of prescription medications is beyond the scope of Marias Medical Center. Jessica, does MMC provide information to patients regarding financials assistance for prescription drugs? Marias Medical Center recently hired one new primary care provider since the results of the needs assessment were received. Marias Medical Center participates in the Hill-Burton program and promotes the program to patients who could qualify to receive financial assistance with healthcare bills. Providing home health care for the community is currently beyond the capacity of Marias Medical Center. Implementing local home health care would require a collaborative approach among health agencies in the community and may be pursued at a future time. 24
Dissemination of Needs Assessment Marias Medical Center MMC disseminated the community health needs assessment and implementation plan by posting both documents conspicuously on their website (mmcmt.org) as well as having copies available at the facility (and anywhere else?) should community members request to view the community health needs assessment or the implementation planning documents. The Steering Committee, which was formed specifically as a result of the CHSD [Community Health Services Development] process to introduce the community to the assessment process, will be informed of the implementation plan to see the value of their input and time in the CHSD process as well as how MMC is utilizing their input. The Steering Committee, as well as the Board of Directors, will be encouraged to act as advocates in Toole County as the facility seeks to address the healthcare needs of their community. Furthermore, the board members of MMC will be directed to the hospital s website to view the complete assessment results and the implementation plan. MMC board members approved and adopted the plan on Month ##, 2014. Board members are encouraged to familiarize themselves with the needs assessment report and implementation plan so they can publically promote the facility s plan to influence the community in a beneficial manner. MMC will establish an ongoing feedback mechanism to take into account any written comments it may receive on the adopted implementation plan document. [Please remove the following statement, the watermark, and the disclaimer in the footer once the planning document is finalized] *Please note that you will need to include information specific to these requirements: - You must post your community health needs assessment (CHNA) and your facility s implementation plan publicly both conspicuously on your website as well as have a hard copy available at your facility should someone request to view either/both documents. o Your documents must remain on the web until two subsequent CHNA reports have been posted o An individual must not be required to create an account or provide personally identifiable information to access the report o A paper copy must be available for public inspection without charge - Your facility s implementation plan must be approved and the plan must document the date upon which the plan was approved/adopted 25