Every hospital CEO in America is looking at a plate full of challenges these days, with some obstacles larger than others. Rural hospitals, however, are expected to overcome the same industry hurdles but with limited resources. While hospitals in small-town America have their advantages, it takes well-connected and driven leadership to keep a rural hospital on the cusp.
Kathy Kuck, RN, has served as president and CEO of Pocono Health System in East Stroudsburg, Pa., since 2008. She began her career as a nurse, eventually moving on to hold leadership positions at healthcare organizations in various shapes and sizes — academic medical centers, urban hospitals, community hospitals and nursing homes.
Ms. Kuck says her leadership style is an informal one — she is involved in hospital operations, is close-knit with hospital staff and doesn't lead from an ivory tower removed from the heart of the hospital. Here, Ms. Kuck discusses challenges such as physician recruitment and population health management, and also shares the best piece of professional advice she's ever received.
Q: As someone who has worked in both urban and rural healthcare settings, what have you found to be the starkest differences between the two?
Ms. Kuck: In many aspects, you'd think working in a large, urban hospital would be much more complex. There's certainly an added layer of complexity, but while the performance requirements of any CEO are the same — same standards, same rules — our resources are certainly not the same. You have multiple levels in an academic setting, and there are a lot of people [to whom] you can delegate responsibility.
In a rural facility, those numbers are small. You might have one [person performing] this particular job; you don't have a department full of 15 people. The same resources aren't there, but the requirements aren't any less — things like value-based purchasing and meeting Joint Commission standards. We need to do it all.
Q: What is unique about the rural hospital C-suite, specifically?
KK: For executives, our visibility is much greater in rural settings. We can't go to the grocery store without someone recognizing us. Our accountability to the people we serve seems to be much greater. They're right there, interacting with us, even when we're not in the work setting. One distinct difference [between the two settings] is that our mission is very real — it's in our face every day, and that's not a bad thing. It keeps us rooted.
In a rural setting, the levels of management are [much more] flat than you'd see in a larger, complex [organization]. My hands are inevitably in [hospital] operations every day. I'm much closer to my staff, who know me and my personality. I'm not in an ivory tower. Staff members don't hesitate to stop me in the hall to ask a question or comment, and that's a good thing. I enjoy that. It's much more than, 'As CEO, I'm going to bless you all with my presence once per quarter.'
Q: How do these close community ties influence Pocono's strategic planning?
KK: Instead of doing usual public meetings here at Pocono, we decided this year to present the community needs assessment to the community. We worked with our local university and commissioned them to conduct a needs-assessment survey. We asked them to have focus group meetings with community members, faith-based leaders and business leaders to let them have input. They told us what they perceived to be the health needs for the community.
At this meeting, we had folks from the university present the data, and I requested key leaders to serve on a panel and present what they perceive to be community needs, what they're planning to do and what Pocono should do. Now, those folks who served on the panel are on a steering committee with us. We've narrowed down our needs to focus on behavioral health and wellness. We're working with people from the community, who are sitting at the table with us, on how to improve community health. We call this county-wide initiative Community Health Connections, and Pocono is an equal partner in it.
Q: Are there any challenges on your plate that might be unique to hospitals in rural settings?
KK: The needs of our community are just as comprehensive as more urban settings. But we're in rural America, and in order for me to have sufficient depth and breadth of physicians — that poses more of a challenge. A smaller, rural facility can't afford to have five of everybody. But if I hire in one person in a particular area, it may not be enough. I need 1.5 but I can't hire a half — I'd have to hire two. Small hospitals have to realize that we can't be all things to all people. That's where telemedicine and telehealth comes in.
Q: Have you encountered physician recruitment challenges due to your location? If so, how are you dealing with that?
KK: I think it's always difficult to recruit physicians to a rural area. Where's the social environment? The city is nearby, but social structures are very difficult in rural areas, especially for young people. If they're single or don't have children, where do you develop friendships and where does your social network come from?
[Physician recruitment] is improving as our reputation and scope of services expands. We are within the top 5 percent for clinical excellence, according to HealthGrades. We have a 3-star cardiac surgery program [according to HealthGrades]. As we raise the bar, it becomes easier to recruit. More physicians want to be employed, and we provide a lot of physician support with mid-level providers.
While we're not an academic medical center, we've affiliated with the Commonwealth Medical College in Scranton, Pa. We have medical students rotating through, and we're going to take care of them very well. We're also looking to bring surgery and internal medicine residency programs to Pocono. We're hoping what that does is say, 'We've treated you well, you can see the good work we're doing here. If you want, come here for your residency. And now we'll offer you a job.' That partnership with Commonwealth started within this past academic year, and we're in discussions with them now to become the school's fourth regional campus.
Q. What is the best piece of professional advice you've ever received?
KK: "Always make it about the mission." It makes decision-making very easy. That was drummed into me, and I believe that you'll always make the right choices [under the mission]. It's a question I ask myself with every single decision point: Is this consistent with our mission?
A lot of folks have always been concerned about the "deal with the doc." Well, if I make this deal, is it in the best interest of the patient? If I speak to employees and grant their requests, is it consistent with our mission? If we can't do it well, we shouldn't be doing it. If we don't have the resources to support it, why would I do it? Some people may worry about volume or ask if I'm worried physicians might leave if I say "no" to them. Well, it's about the mission. That's printed forever in my brain.
Q: You took the reigns at Pocono in 2008. Can you recall some high points of your career throughout the time since?
KK: I've been on a continuous high — as we continue to grow, it's been a steady growth of services. When I look at all of that, [I realize] this is really an unprecedented time for Pocono and many rural hospitals. It began with developing our heart and vascular institute. It's a full-service center with open heart surgery. We have a chest pain center that recently earned three-year accreditation by the Society of Chest Pain Centers. It's one of only 10 hospitals in Pennsylvania to have received that designation. Last March, PMC received full heart failure accreditation from the Society of Chest Pain Centers. We also have a new rapid-treatment center to care for people on an outpatient basis.
We have a new Level III trauma center and our emergency room sees about 90,000 visits per year. We think it's important to keep folks as close to home as possible. We've also brought a new spine surgery program here as well as more bariatrics and gynecology services. For women's needs, we built a Level III neo-natal intensive care unit. We're also doing robotic surgery now and we've built medical homes, because that's the future of healthcare. In June, we're planning to open our new comprehensive cancer center, since cancer is the leading cause of death in our community.
Within these four years we've been moving nonstop. I think being able to provide these services is absolutely bringing me the most pleasure. The voice of the community has changed. People say, "Ten years ago I wouldn't have gone to Pocono, but I'd go there now."
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Kathy Kuck, RN, has served as president and CEO of Pocono Health System in East Stroudsburg, Pa., since 2008. She began her career as a nurse, eventually moving on to hold leadership positions at healthcare organizations in various shapes and sizes — academic medical centers, urban hospitals, community hospitals and nursing homes. Ms. Kuck says her leadership style is an informal one — she is involved in hospital operations, is close-knit with hospital staff and doesn't lead from an ivory tower removed from the heart of the hospital. Here, Ms. Kuck discusses challenges such as physician recruitment and population health management, and also shares the best piece of professional advice she's ever received.
Q: As someone who has worked in both urban and rural healthcare settings, what have you found to be the starkest differences between the two?
Ms. Kuck: In many aspects, you'd think working in a large, urban hospital would be much more complex. There's certainly an added layer of complexity, but while the performance requirements of any CEO are the same — same standards, same rules — our resources are certainly not the same. You have multiple levels in an academic setting, and there are a lot of people [to whom] you can delegate responsibility.
In a rural facility, those numbers are small. You might have one [person performing] this particular job; you don't have a department full of 15 people. The same resources aren't there, but the requirements aren't any less — things like value-based purchasing and meeting Joint Commission standards. We need to do it all.
Q: What is unique about the rural hospital C-suite, specifically?
KK: For executives, our visibility is much greater in rural settings. We can't go to the grocery store without someone recognizing us. Our accountability to the people we serve seems to be much greater. They're right there, interacting with us, even when we're not in the work setting. One distinct difference [between the two settings] is that our mission is very real — it's in our face every day, and that's not a bad thing. It keeps us rooted.
In a rural setting, the levels of management are [much more] flat than you'd see in a larger, complex [organization]. My hands are inevitably in [hospital] operations every day. I'm much closer to my staff, who know me and my personality. I'm not in an ivory tower. Staff members don't hesitate to stop me in the hall to ask a question or comment, and that's a good thing. I enjoy that. It's much more than, 'As CEO, I'm going to bless you all with my presence once per quarter.'
Q: How do these close community ties influence Pocono's strategic planning?
KK: Instead of doing usual public meetings here at Pocono, we decided this year to present the community needs assessment to the community. We worked with our local university and commissioned them to conduct a needs-assessment survey. We asked them to have focus group meetings with community members, faith-based leaders and business leaders to let them have input. They told us what they perceived to be the health needs for the community.
At this meeting, we had folks from the university present the data, and I requested key leaders to serve on a panel and present what they perceive to be community needs, what they're planning to do and what Pocono should do. Now, those folks who served on the panel are on a steering committee with us. We've narrowed down our needs to focus on behavioral health and wellness. We're working with people from the community, who are sitting at the table with us, on how to improve community health. We call this county-wide initiative Community Health Connections, and Pocono is an equal partner in it.
Q: Are there any challenges on your plate that might be unique to hospitals in rural settings?
KK: The needs of our community are just as comprehensive as more urban settings. But we're in rural America, and in order for me to have sufficient depth and breadth of physicians — that poses more of a challenge. A smaller, rural facility can't afford to have five of everybody. But if I hire in one person in a particular area, it may not be enough. I need 1.5 but I can't hire a half — I'd have to hire two. Small hospitals have to realize that we can't be all things to all people. That's where telemedicine and telehealth comes in.
Q: Have you encountered physician recruitment challenges due to your location? If so, how are you dealing with that?
KK: I think it's always difficult to recruit physicians to a rural area. Where's the social environment? The city is nearby, but social structures are very difficult in rural areas, especially for young people. If they're single or don't have children, where do you develop friendships and where does your social network come from?
[Physician recruitment] is improving as our reputation and scope of services expands. We are within the top 5 percent for clinical excellence, according to HealthGrades. We have a 3-star cardiac surgery program [according to HealthGrades]. As we raise the bar, it becomes easier to recruit. More physicians want to be employed, and we provide a lot of physician support with mid-level providers.
While we're not an academic medical center, we've affiliated with the Commonwealth Medical College in Scranton, Pa. We have medical students rotating through, and we're going to take care of them very well. We're also looking to bring surgery and internal medicine residency programs to Pocono. We're hoping what that does is say, 'We've treated you well, you can see the good work we're doing here. If you want, come here for your residency. And now we'll offer you a job.' That partnership with Commonwealth started within this past academic year, and we're in discussions with them now to become the school's fourth regional campus.
Q. What is the best piece of professional advice you've ever received?
KK: "Always make it about the mission." It makes decision-making very easy. That was drummed into me, and I believe that you'll always make the right choices [under the mission]. It's a question I ask myself with every single decision point: Is this consistent with our mission?
A lot of folks have always been concerned about the "deal with the doc." Well, if I make this deal, is it in the best interest of the patient? If I speak to employees and grant their requests, is it consistent with our mission? If we can't do it well, we shouldn't be doing it. If we don't have the resources to support it, why would I do it? Some people may worry about volume or ask if I'm worried physicians might leave if I say "no" to them. Well, it's about the mission. That's printed forever in my brain.
Q: You took the reigns at Pocono in 2008. Can you recall some high points of your career throughout the time since?
KK: I've been on a continuous high — as we continue to grow, it's been a steady growth of services. When I look at all of that, [I realize] this is really an unprecedented time for Pocono and many rural hospitals. It began with developing our heart and vascular institute. It's a full-service center with open heart surgery. We have a chest pain center that recently earned three-year accreditation by the Society of Chest Pain Centers. It's one of only 10 hospitals in Pennsylvania to have received that designation. Last March, PMC received full heart failure accreditation from the Society of Chest Pain Centers. We also have a new rapid-treatment center to care for people on an outpatient basis.
We have a new Level III trauma center and our emergency room sees about 90,000 visits per year. We think it's important to keep folks as close to home as possible. We've also brought a new spine surgery program here as well as more bariatrics and gynecology services. For women's needs, we built a Level III neo-natal intensive care unit. We're also doing robotic surgery now and we've built medical homes, because that's the future of healthcare. In June, we're planning to open our new comprehensive cancer center, since cancer is the leading cause of death in our community.
Within these four years we've been moving nonstop. I think being able to provide these services is absolutely bringing me the most pleasure. The voice of the community has changed. People say, "Ten years ago I wouldn't have gone to Pocono, but I'd go there now."
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