Navigating Challenges During Times of Change—One Rural Hospital’s Perspective

When the Covid-19 pandemic put a stop to elective surgeries everywhere, Hot Springs County Memorial Hospital in Thermopolis, Wyoming, saw a 60% reduction in revenue in the first two months alone. While many hospitals across the country made the difficult but financially sound decision to furlough employees—hospitals shed 135,000 jobs in April alone—the 15-bed critical access hospital located more than two hours from the nearest tertiary center in Casper didn’t have that option.

“We committed to keeping our people working because we worked so hard to recruit them,” says Margie Molitor, RN, FACHE, chief executive officer. “Once you get them, you do whatever you can to keep them.”

Instead of furloughs or hour reductions, the hospital got creative, shifting employees around where the need was greatest, which turned out to be the emergency department. Unaware of how the virus would impact the community, the hospital worked quickly to create what was essentially two ERs (and emergency care teams)—one for patients who presented to the ER with COVID-19 symptoms and the other for all other patients. When elective surgeries resumed, the hospital returned to its regular staffing.

Developing and retaining a qualified and engaged workforce is among the biggest challenge for a hospital like Hot Springs County Memorial. While healthcare worker shortages, affecting the supply of technicians, nurses, pharmacists and physicians, are problems all across the country, the issue is magnified in a rural community like Thermopolis.

“I’ve found that you have to be very upfront with people,” she says. “A lot of people don’t understand what rural in Wyoming means. We’re an hour away from the closest Walmart, two hours away from the closest mall. You just want to make sure people understand that it’s different. I think it’s good, but it’s different.”

Molitor’s first preference is recruiting from within the region. “The best thing for a rural community is to grow your own talent,” she says. “They already know what’s it’s like to live here. All you have to do is find ones that are eager to learn and would make a good part of your team.”

The hospital partners with regional community colleges and will pay to educate staff who show promise for new jobs. This summer, Molitor hired a nurse whose schooling was paid for by the hospital. Last year, a new lab technician received tuition support, as well.

One advantage Thermopolis has that many rural communities don’t is its picturesque location and great outdoors—hot springs, hunting, hiking and fishing are in the hospital’s back yard. Yellowstone National Park can be reached in two hours; Jackson Hole in four.

But, Molitor says there’s a lot to offer inside the hospital walls. “This is a great place to work,” she says. “We have a great organizational culture that prioritizes mutual support and respect and opportunities for growth.”

In fact, the hospital is the site for the state’s first rural residency program. “These students keep us on our game,” Molitor says. “They know the newest and best treatments and they challenge us to stay up to date and current, which is good for our physicians.”

When recruiting physicians, Molitor says touting your existing physician team is important. “It’s much easier to recruit into an established group of physicians,” she says. “They know they have someone who will have their back. New physicians want to know there is a group of peers who will help them grow and develop.”

It also can’t hurt recruitment when your facility is shiny and new. A recent renovation and addition, which was 20 years in the making, refurbished patient rooms and reconfigured existing spaces to accommodate the evolving needs of the hospital.

“There’s always the financial challenge of how to make sure you have a viable operation, especially if you’re a freestanding hospital like we are,” she says.

The hospital, which used to have 25 beds, dropped down to 15 after recognizing that the average daily census of five patients left most beds unused. A 30,000 square foot addition that was completed in January 2020 produced a brand-new operating room, emergency department and med/surg unit. The inpatient rooms were modernized to provide more spacious bathrooms that now include showers.

“We probably would have built more beds had we had more money,” she says. “Instead, we had to ask, ‘What does our community need and what can we afford?’ The result has been a very functional, patient friendly, staff friendly environment.”

Molitor is one of four hospital leaders participating in the upcoming HealthTechS3 webinar, Rural Healthcare Challenge in Times of Change. The webinar will focus on the challenges facing rural healthcare, and innovative and practical strategies to address those challenges from both the CEO and CNO perspective. Mark your calendar for Friday, Sept. 11, at noon CST. Sign up today.