Desiree Einsweiler has had an eventful year. In January, she was named interim administrator of Mitchell County Regional Health Center in Osage, Iowa, a partner facility of Mercy Medical Center-North Iowa in Mason City and a Trinity Health hospital. While overseeing the organization, she continued her previous role of as regional clinic director of MMC-North Iowa, the northern outpost of Des Moines-based Iowa Mercy Health Nework — a position she has held for four years. On May 7, she'll step down from the interim role at Mitchell to take a permanent CEO position at Palo Alto County Health System in Emmetsburg, Iowa. The 25-bed critical-access hospital also partners with MMC-North Iowa in a management service agreement that provides the small rural hospital C-suite leadership and recruitment services.
Growing up not far from the Iowa-Illinois border, the one-time Ithaca College film major didn't initially see herself as a hospital CEO. But, after realizing she didn't really want to make movies, she returned to the Midwest, enrolled in the University of Iowa's graduate program in health administration and hasn't left the state since. At only 29, she's certainly one of the youngest hospital CEOs in the country, and she says it doesn't go unnoticed. "I get asked a lot how hold I am; people say I look to young to be a hospital CEO," she says. "But as you work with people and through things, if you can make a difference with a plan and a strategy, then they begin to forget your age."
Here Ms. Einsweiler discusses her career thus far and the challenges she expects to faces as one of the newest hospital CEOs in the Hawkeye state.
Question: You were named interim administrator at Mitchell County Regional Health Center in January and will be starting as CEO of Palo Alto County Health System in May. How have the challenges of overseeing a 25-bed critical access hospital differed from your previous position of overseeing outpatient clinics?
Ms. Einsweiler: The obvious answer is the scope of responsibility. Instead of being responsible for one service line (outpatient clinics), I have responsibility for many varying services lines (everything from inpatient care to lab to purchasing to facilities). I am constantly learning new things and recognizing the value of having strong, reliable directors and managers. Having said that, what I find more interesting than the differences are the similarities between the two roles. Being a good administrator, no matter what the service line or scope of responsibility, is about being able to understand and anticipate the market, create strategic goals and plans to work toward and achieve those goals, and being able to successfully communicate with and support your staff and providers.
Q: What are your biggest goals for Mitchell and/or Palo Alto and/or your clinics in the coming year?
DE: I am just getting started in Palo Alto, so my first goal is simply to become familiar with and understand the organization and the people. After that, our goal will be to review and update both our long- and short-term strategic plans. I know PACHS is already doing great things, but we want to be sure that we keep moving in the right direction.
Q: How will reform impact Palo Alto and other critical access hospitals?
DE: We know that regardless of what the Supreme Court decides, we need to continue to focus on improving quality. Both MCRHC and PACHS are participating in the Iowa Healthcare Collaborative's Hospital Engagement Network initiative. This initiative identifies 10 focus areas that affect quality and patient safety, and focuses on improving these areas so that we can decrease preventable hospital-acquired conditions by 40 percent by the end of 2013 and reduce avoidable hospital readmissions by 20 percent by the end of 2013 across the state of Iowa. We also need to continue to improve processes through Lean in order to work more efficiently and reduce expenses. And we need to embrace the idea of patient-centered, coordinated care and create an organizational structure that that is centered on these ideals.
Q: How will the role of critical access hospitals change as healthcare moves to a more coordinated and outpatient model?
DE: CAHs play an important role in our healthcare system. They allow people to obtain quality medical care in their own community, without having to travel. I believe that even though reimbursement structures may change, CAHs will continue to play this very important role. Of course, this doesn't mean that we can sit back and take it easy. We need to adapt our service delivery model in order to survive. We need to ensure that we have primary care clinics that are designated as medical homes, and we need to partner with other healthcare service lines to ensure we can deliver care across the continuum. Partnering with Mercy is great for us as a community hospital not only because of the resources and shared knowledge that this relationship affords us, but also because it allows us to offer a continuum of care to our patients that we might otherwise not be able to offer.
Q: One of your duties in your previous role as director of clinics was to recruit new physicians to Mercy. I would imagine there are challenges in recruiting to a somewhat rural area of Iowa? How did you sell your clinics and the Mercy network?
DE: Yes, it can be a struggle to recruit physicians to practices in rural Iowa, but many people don't realize all of the great things that Iowa has to offer. We have an excellent school system, low cost of living, a variety of recreational activities and one of the lowest unemployment rates in the country. Iowa may not be for everyone, but if you are a physician looking for a practice in which you can really connect with your patients and a community which you can become a part of and raise your children, Iowa might be for you. We also recognize that as a physician, you spend a lot of time at work so it is important to be a part of a practice where you feel comfortable. Our physicians are not just employees — they are our partners. We value their input in strategy and decision-making. If we can get a physician candidate to come and visit us, speak with our physicians and get a better feel for the community and practice, they can see what we really have to offer.
Q: You previously mentioned the need to continue to implement Lean process improvement to continue to increase quality and efficiency, something you are familiar with through your role with Mercy's clinics. What led to the implementation of Lean and what were some of the areas you focused on?
DE: Everyone in healthcare is facing lower reimbursement and rising costs. As an organization, we recognized the need to become more efficient; to produce better results at a lower cost; to start working smarter, not harder. And we wanted to do this in a way that would engage the staff. So we started the Lean journey.
We have made some really outstanding process changes in the clinics. We start each clinic day with a huddle during which staff share ideas for improvements, discuss safety issues, discuss key operating metrics and share celebrations. It is all about keeping things visual. Problem-solving white boards hang on the walls so everyone can see the problems being focused on at the time, and all the business metrics hang on our business wall.
In our pilot clinic, we implemented level-loaded schedules based on the demand for various visit types, created standard work for almost all clinic processes and implemented one-piece-flow dictation, which means the providers dictate after every visit. Although many skeptics say that it isn't possible to build dictation time into a provider's day while maintaining productivity levels, we were able to do this and actually increase productivity levels without adding any additional work hours for the provider, not to mention we increased our coding index and improved customer satisfaction by being able to turn test results around almost immediately. We also implemented a new staffing structure with a team lead to ensure that the day runs smoothly. When a problem arises, the team uses A3 problem-solving to find a root cause and implement a countermeasure on the spot. They create a solution so that the problem does not occur again, rather than just putting a "band-aid" on the issue. I am so proud of my staff for the work they have done. They have gone above and beyond all of my expectations.
Q: What made you want to enter the field of healthcare administration?
DE: Actually, it is kind of an odd story. When I entered college, I wanted to be a film producer. After one semester of film school, I realized that film production wasn’t the career for me. I had always been interested in healthcare, and just happened to be taking some medical terminology and medical management courses "for fun" at the time. Yes, you heard that correctly. I spoke to my professor about pursing healthcare management as a career and it sounded like it would fit my interests. I switched my major, and here I am. I sort of stumbled upon this as a career, but I love what I do and the challenges keep it interesting.
Q: What has been the biggest learning so far in your career?
DE: You know, it sounds simple, but my biggest learning is the importance of communication. I have seen the best ideas and greatest of intentions go horribly wrong due to a lack of communication. People need to understand the what, why and how in order to be fully engaged; if you can't communicate that to them, it becomes a real barrier.
Q: If you could change one thing about healthcare in the U.S. what would it be?
DE: I have studied healthcare systems across the world and the one thing I realized is that there is no such thing as a perfect system, but I think we are moving in the right direction. Yes, it means we will have to adapt our business models, but I think we are up to the challenge. Of course, having said that, it would be nice to see some stabilization in the payment structure. Every year we have to deal with larger reimbursement cuts and are hanging on the edge of our seats wondering what kind of cuts we will see from Medicare and Medicaid.
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Growing up not far from the Iowa-Illinois border, the one-time Ithaca College film major didn't initially see herself as a hospital CEO. But, after realizing she didn't really want to make movies, she returned to the Midwest, enrolled in the University of Iowa's graduate program in health administration and hasn't left the state since. At only 29, she's certainly one of the youngest hospital CEOs in the country, and she says it doesn't go unnoticed. "I get asked a lot how hold I am; people say I look to young to be a hospital CEO," she says. "But as you work with people and through things, if you can make a difference with a plan and a strategy, then they begin to forget your age."Here Ms. Einsweiler discusses her career thus far and the challenges she expects to faces as one of the newest hospital CEOs in the Hawkeye state.
Question: You were named interim administrator at Mitchell County Regional Health Center in January and will be starting as CEO of Palo Alto County Health System in May. How have the challenges of overseeing a 25-bed critical access hospital differed from your previous position of overseeing outpatient clinics?
Ms. Einsweiler: The obvious answer is the scope of responsibility. Instead of being responsible for one service line (outpatient clinics), I have responsibility for many varying services lines (everything from inpatient care to lab to purchasing to facilities). I am constantly learning new things and recognizing the value of having strong, reliable directors and managers. Having said that, what I find more interesting than the differences are the similarities between the two roles. Being a good administrator, no matter what the service line or scope of responsibility, is about being able to understand and anticipate the market, create strategic goals and plans to work toward and achieve those goals, and being able to successfully communicate with and support your staff and providers.
Q: What are your biggest goals for Mitchell and/or Palo Alto and/or your clinics in the coming year?
DE: I am just getting started in Palo Alto, so my first goal is simply to become familiar with and understand the organization and the people. After that, our goal will be to review and update both our long- and short-term strategic plans. I know PACHS is already doing great things, but we want to be sure that we keep moving in the right direction.
Q: How will reform impact Palo Alto and other critical access hospitals?
DE: We know that regardless of what the Supreme Court decides, we need to continue to focus on improving quality. Both MCRHC and PACHS are participating in the Iowa Healthcare Collaborative's Hospital Engagement Network initiative. This initiative identifies 10 focus areas that affect quality and patient safety, and focuses on improving these areas so that we can decrease preventable hospital-acquired conditions by 40 percent by the end of 2013 and reduce avoidable hospital readmissions by 20 percent by the end of 2013 across the state of Iowa. We also need to continue to improve processes through Lean in order to work more efficiently and reduce expenses. And we need to embrace the idea of patient-centered, coordinated care and create an organizational structure that that is centered on these ideals.
Q: How will the role of critical access hospitals change as healthcare moves to a more coordinated and outpatient model?
DE: CAHs play an important role in our healthcare system. They allow people to obtain quality medical care in their own community, without having to travel. I believe that even though reimbursement structures may change, CAHs will continue to play this very important role. Of course, this doesn't mean that we can sit back and take it easy. We need to adapt our service delivery model in order to survive. We need to ensure that we have primary care clinics that are designated as medical homes, and we need to partner with other healthcare service lines to ensure we can deliver care across the continuum. Partnering with Mercy is great for us as a community hospital not only because of the resources and shared knowledge that this relationship affords us, but also because it allows us to offer a continuum of care to our patients that we might otherwise not be able to offer.
Q: One of your duties in your previous role as director of clinics was to recruit new physicians to Mercy. I would imagine there are challenges in recruiting to a somewhat rural area of Iowa? How did you sell your clinics and the Mercy network?
DE: Yes, it can be a struggle to recruit physicians to practices in rural Iowa, but many people don't realize all of the great things that Iowa has to offer. We have an excellent school system, low cost of living, a variety of recreational activities and one of the lowest unemployment rates in the country. Iowa may not be for everyone, but if you are a physician looking for a practice in which you can really connect with your patients and a community which you can become a part of and raise your children, Iowa might be for you. We also recognize that as a physician, you spend a lot of time at work so it is important to be a part of a practice where you feel comfortable. Our physicians are not just employees — they are our partners. We value their input in strategy and decision-making. If we can get a physician candidate to come and visit us, speak with our physicians and get a better feel for the community and practice, they can see what we really have to offer.
Q: You previously mentioned the need to continue to implement Lean process improvement to continue to increase quality and efficiency, something you are familiar with through your role with Mercy's clinics. What led to the implementation of Lean and what were some of the areas you focused on?
DE: Everyone in healthcare is facing lower reimbursement and rising costs. As an organization, we recognized the need to become more efficient; to produce better results at a lower cost; to start working smarter, not harder. And we wanted to do this in a way that would engage the staff. So we started the Lean journey.
We have made some really outstanding process changes in the clinics. We start each clinic day with a huddle during which staff share ideas for improvements, discuss safety issues, discuss key operating metrics and share celebrations. It is all about keeping things visual. Problem-solving white boards hang on the walls so everyone can see the problems being focused on at the time, and all the business metrics hang on our business wall.
In our pilot clinic, we implemented level-loaded schedules based on the demand for various visit types, created standard work for almost all clinic processes and implemented one-piece-flow dictation, which means the providers dictate after every visit. Although many skeptics say that it isn't possible to build dictation time into a provider's day while maintaining productivity levels, we were able to do this and actually increase productivity levels without adding any additional work hours for the provider, not to mention we increased our coding index and improved customer satisfaction by being able to turn test results around almost immediately. We also implemented a new staffing structure with a team lead to ensure that the day runs smoothly. When a problem arises, the team uses A3 problem-solving to find a root cause and implement a countermeasure on the spot. They create a solution so that the problem does not occur again, rather than just putting a "band-aid" on the issue. I am so proud of my staff for the work they have done. They have gone above and beyond all of my expectations.
Q: What made you want to enter the field of healthcare administration?
DE: Actually, it is kind of an odd story. When I entered college, I wanted to be a film producer. After one semester of film school, I realized that film production wasn’t the career for me. I had always been interested in healthcare, and just happened to be taking some medical terminology and medical management courses "for fun" at the time. Yes, you heard that correctly. I spoke to my professor about pursing healthcare management as a career and it sounded like it would fit my interests. I switched my major, and here I am. I sort of stumbled upon this as a career, but I love what I do and the challenges keep it interesting.
Q: What has been the biggest learning so far in your career?
DE: You know, it sounds simple, but my biggest learning is the importance of communication. I have seen the best ideas and greatest of intentions go horribly wrong due to a lack of communication. People need to understand the what, why and how in order to be fully engaged; if you can't communicate that to them, it becomes a real barrier.
Q: If you could change one thing about healthcare in the U.S. what would it be?
DE: I have studied healthcare systems across the world and the one thing I realized is that there is no such thing as a perfect system, but I think we are moving in the right direction. Yes, it means we will have to adapt our business models, but I think we are up to the challenge. Of course, having said that, it would be nice to see some stabilization in the payment structure. Every year we have to deal with larger reimbursement cuts and are hanging on the edge of our seats wondering what kind of cuts we will see from Medicare and Medicaid.
More Interviews With Hospital CEOs:
Leaving the Ivory Tower Behind: Q&A With Kathy Kuck, CEO of Pocono Health SystemPursuing Hospital Mastery: Q&A With Experienced Hospital CEO Mark Dixon
A "Lean" Vision Drives Stanford Hospital & Clinics Performance: Q&A With CEO Amir Dan Rubin