Rural Healthcare: A CEO's Take on Advocacy, Tech and More

Phil Sobol: Lynn Falcone is the CEO of Cuero Regional Hospital and a healthcare executive, with more than 30 years of experience working in for-profit, not-for-profit, and government hospitals. She is known for the many ways she puts patients, providers, clinical care teams, and quality patient care first.

She is an active board member of the Texas organization of rural and community hospitals and is a gifted mentor, coach, and relationship builder. Lynn, thank you very much for joining the CereCore podcast today.

Lynn Falcone: Thanks for having me, Phil, I am happy to be here.

Sobol: Wonderful. Well, we always like to start with a little bit of background. So, Lynn, if you do not mind, take our listeners, who are mostly healthcare IT leaders, into Cuero Regional Hospital and rural healthcare in Texas. What should our audience understand about healthcare operations in your community? What are some of the toughest challenges you face? Maybe something that might be surprising about running a hospital in rural Texas. You name it, just take us behind the scenes of your world as CEO.

Falcone: Sure, I am always happy to brag about my hospital and talk about my team here. I think in a rural setting, your sense of team is incredibly important to be successful. I spent most of my health care career in large urban settings.

So, getting used to rural healthcare was a little bit of an eye opener. I have been here for almost eight years now, and my hospital is a 49-bed rural hospital, we are a PPS (prospective payment system) hospital versus critical access.

We have a wide array of services: medical surge telemetry, surgical procedures, we have an active emergency department, we offer intensive care services, and we still deliver babies. We are one of the rural hospitals that still does have the opportunity to deliver babies. We also own and operate the home health agency and we own and operate EMS. And that is something you would not find in a large setting. It is common in a rural setting, but it is really not across the board.

We also own and operate a wellness center in town, which really gets at how we help take care of our community. And finally, we have five rural health clinics, which I employ about eight different providers and six different mid-levels across those clinics. I have two in Cuero and three outside of the community to really take care of other rural settings adjacent to Cuero.

We cast a fairly broad net for an organization our size. We employ roughly 400 people in and amongst all of those services. We are a tax district, which is a whole different level. So, I report to the board here in Cuero, it is a five-person board. I think some of the things that I had to get used to, like I said, I have been here for almost eight years, but when I go to the local H-E-B, I'm still the new administrator and it all goes to what I am being compared to. My chief nursing officer has been here for a little over 40 years. My assistant administrator has been here for over 30 years and some of my nursing leaders and other leaders have very long tenure. So, I feel pretty good after almost eight years and there is a lot of stability in that sense. So, that kind of draws the picture of what we offer to our community.

Sobol: Oh, that is fantastic. You touched on the community, the board, and still after eight years, being the newcomer to that. And so, it kind of dovetails nicely into, how has that journey changed for you, when it comes to your interactions with the board and the community? Have you been able to begin to earn that trust and buy in as you move forward? And, maybe just tell us a little bit about those relationships and how you have been able to manage those.

Falcone: I think in any setting, but probably more so in a rural setting, it is important to get involved in your community. When I came, we were a little unique in that, back in 2015 and 2016, the board of directors struck an agreement with the Methodist Healthcare System in San Antonio to strike up an affiliation agreement. The board at that time began to see the struggle of rural facilities and the number of rural hospitals that had been closing and were looking at partnerships to help make sure that did not happen. And so, when I came in under the Methodist partnership, there was a lot of angst that Methodist was owning the hospital and that is truly not the case.

It is an affiliation agreement, and we have access to HealthTrust Purchasing Group and education policies and the education is a big piece. So, not only was there overcoming the new administrator role, but trying to convince the community that this was a good move, and not to shun the organization because an outsider owned it, and the board did still really hold the control.

Over the last several years, I have been involved in the Rotary Club. Early on, I also changed our employee evaluations to include the requirement that employees must donate 3 hours of volunteer time to our community, and they wear their hospital shirts to let the community know that there is large representation. We are the largest employer in the county and so let them see what role the hospital plays outside of just providing health care. And each of my senior leaders in the organization are a part of a different local entity, like the chamber.

I recently was put on the Cuero Development Corporation and now serve as the vice president there. So, it is how do you get in and how do you get out to those communities? We undertake a lot of different activities across our community. Right now, for breast cancer awareness month we are out at all the local football games. The Cuero football game, I was at the Yokum on Friday night, Golia this week, and Kennedy the following week, and dressed in our shirts, and really doing what we can to promote breast cancer awareness. So, it is just as the leader, it is more and more important to get out into the community and create those relationships.

Sobol: It is spot on, and it is a story that we hear quite a lot. But certainly, community involvement is just so critical because you are delivering an amazing service, but at the same point, they also need to see you in their daily lives too, when it is not an emergency type of situation. So, that is fantastic.

Falcone: I was just going to add to that, people do not think about healthcare until you need healthcare. The hospital is there, and I drive by it every other day. But what we have found is working with our community to find out why they might go someplace else. Are they not aware that we have the service? Are they not aware that we can do it? So, we have really undertaken an awareness campaign most recently and I am really happy to say that I never dreamed in a rural hospital that I would have a da Vinci surgical system robot, but I now have a surgeon and a da Vinci robot.

I also have the first 3T MRI in the area and that has pulled a lot of people into our organization that maybe would have bypassed us. So, working with my staff, I really believe that rural facilities must work harder at quality and safety. Because there is an image in many people's minds that you do not get the quality that you would get in a larger hospital, the mindset that bigger is always better.

Having worked at both, I would be a staunch supporter to say that is not true and I am just really proud of the fact that we have been a top 100 hospital. We were four or five years running on the gold plus program for our stroke program. We’re EMS bronze and silver for target stroke and target cardiac for our prehospital services, and making sure that our community is aware of what that means — that they really are in good hands is kind of what we are undertaking right now.

Sobol: Yeah, it is communication. Communication is so critical. So, first, you have got to have the engagement and then you have got to tell the story.

Falcone: Right.

Sobol: And people love to hear those stories and the sense of what you all have done in and for that community is just spectacular. And certainly, now being a part of all of those additional initiatives and boards, et cetera. It is quite an accomplishment and we even touched on the Texas Organization of Rural Community Hospitals, also known as TORCH, earlier. So, yet another thing that you serve on from the board of directors' standpoint. So, tell me a little bit about that collaborative effort that you deal with from a TORCH standpoint, and how that has been helping the community health care in Texas.

Falcone: Well, TORCH is a phenomenal organization, and they are amazing advocates for rural healthcare. John Henderson is the CEO and has phenomenal relationship with the Texas legislators and makes regular trips to DC for all advocacy for rural hospitals.

That is huge, because as a rule administrator, you cannot get your hands into all of that. Knowing that there is someone out there that can help you with that, or you can throw out a lifeline to say, where are we at with this? This type of legislation is huge. Sitting on the board most recently, we initiated the clinically integrated network. So, today's world is all moving towards value-based medicine and our payers are figuring out how not to pay, but we must figure out how to still get money in the door. Some of those changes, like Medicare Advantage plans, I promise I will not get on my soapbox, but it has been very challenging for rural hospitals.

Sobol: Yes.

Falcone: And one of the things that TORCH provides for all rural hospitals, free of charge it comes with your membership, is information and educational information to share with our communities about trying to make an educated decision on whether to go stay with traditional Medicare, go to a Medicare Advantage plan and what is right for you versus, you know, Jimmy J. Walker would never steer you wrong on a TV commercial.

And so, there is a lot of different access in that standpoint. The clinically integrated network is an opportunity for the rural hospitals across the state to band together and negotiate with payers for quality add on bonuses. So, from a compliance standpoint they do not negotiate our contracts, but for different quality measures to help us work together as a team with Medicare Advantage plans, or an accountable care organization that we are doing as a group, and we are learning it as a group. It gives us more power because of what the field brings to the ACO or to the MA plan versus one, standalone hospital. And so honestly, that has been huge for us to be able to feel like you are not on an island all by yourself.

Sobol: It is still so critical. We always like to ask individuals and particularly the ones that are running the hospitals, a question about culture, right? Tell us about your leadership approach and style. You have made mention of the fact that a lot of your senior folks have been with the organization 30 and 40 years established. So, maybe if you would not mind sharing with our listeners, kind of what is your approach?

What is your secret to building that mission motivated, patient focused, and quality driven team? How have you been able to build those relationships and win them over to the vision that you have executed on over the past eight years?

Falcone: Well, I thought back about this one, and there have been so many things that go into how you build your culture. And early on, I really set forth a sense of communication and transparency. And every Friday, with a few exceptions, I email all my staff: what is going on with the state of the union? What is going on in the organization? I might do recognitions, but really establishing a line of communication with all the staff.

We use leadership rounding out and talking to the staff. We do daily patient safety huddles, talking about: what is going on with the patients that are in our house? What has come through the emergency department? What do we need to tackle today? And that is all in the name of transparency communication. Everybody needs to know the why behind what we do.

So, I think it is being approachable. And Phil, you and I have met face-to-face and when I walk in the door at six foot four inches, I can come across as fairly unapproachable. And I think over time I have worked very hard to overcome that and to be very approachable. My joke is, when they see me coming, they do not run any more. They are used to me being out on the floor in the department.

So, I tell them, you are not just a housekeeper, you control the impact of our environment when someone first walks in the door, you are the first impression. When you are the registration clerk, and it takes a whole village and if you do not think you are a part of the village, we need to sit down and chat.

But, it is communication and yes, I might be the CEO or the administrator of the organization, but I am no different than they are when it comes to caring for our community.

Sobol: That is excellent. And, yes, I agree, having strong communication and being in constant communication, being approachable, and listening is so critical for folks that are running these organizations. Whether it is at the helm, like you, or an IT director or a CIO level position. I mean, it is just absolutely critical. I think once people begin to understand that and see that in practice day in and day out, they begin to build trust. And once that trust is established, then it is amazing what an organization can do when they all get on the same page.

Falcone: Years ago, and I cannot tell you exactly when I asked, I think it was at an all-employee forum. Who can tell me what the hospital mission statement is? My CNO, the one that has been here for 40+years, and maybe 2 or 3 other people reluctantly raise their hands because they could recite the mission statement. And so, I identified folks from across the organization and put them in a room and said it is your responsibility you have been identified, and it is not me sitting behind a desk and they rewrote our mission and our vision statement. And now we say that every day before huddle, before staff meetings, just to put us all on the same page for what we are trying to accomplish that day whether at a meeting or at an event. And it has been nice.

Sobol: Yes, that is critical. I think it is and sometimes you can lose sight, or you can lose focus, right? The tasks of the day get overwhelming but, sometimes there is just that simple reminder as to the why.

Falcone: Correct.

Sobol: And tying back to the mission and then it then you are like, okay, I can take a breath. I remember why, and I can execute. So, that is fantastic. So, you have now started on an EHR implementation journey with MEDITECH Expanse.

Falcone: Right.

Sobol: Certainly, particularly for a lot of organizations that have been on legacy MEDITECH systems or other systems in the past. You know, there is always that question of why should we do this? And then really of timing, right? And so, I would love for you to share some of your perspective a little bit as to the why you have chosen as an organization to move towards the modern EHR system. And then, what was it about the timing and what went into making the decision that now was the right time for Cuero?

Falcone: Well, that is such a loaded question. It kind of makes me giggle, but I had been here maybe a year, and the board of directors had been to THA or TORCH meeting, and talking with vendors and new opportunities that were out there and there has been a board push for several years to upgrade our EHR.

When I came in, I was not at all familiar with MEDITECH and quickly realized that we needed a new system, because I could not get data out of my system that was going to help me be a better leader to the organization. For instance, the only way I could find out a particular doctor’s ordering habits for laboratory was how many results printed on his printer — that was my only way to do that.

So I quickly realized, yes, we need to undergo this. However, we started down the path and thought we were ready, and I was very reluctant because I knew that we had a very antiquated structure and infrastructure.

Sobol: Yes.

Falcone: Which was a little scary to learn that we still had tape drives in our organization — that is gone, by the way — but we still had tape drives. And I thought, you could sit in my parking lot and hack my system with a cell phone. We ended up changing some IT leadership and really digging into the right services for us and we knew being a MEDITECH hospital we were going to stay a MEDITECH hospital. The difference was in my five rural health clinics we are Allscripts.

So, we are functioning on 2 two different platforms, which is an incredible challenge for one small organization. So, between data driven, ease of use, we knew that we absolutely had to go this way, but we really spent the last four to five years upgrading our infrastructure, our security systems, and we finally were at the point that we said, okay, now was the time to go.

We have had board support the entire way through, by keeping them informed of the why we were not going to pull the trigger years ago and what we wanted to do over time. But it really took a bit to get the infrastructure up to support any system.

Sobol: It makes good sense. And, just so critical for having that board support, keeping that line of communication open, having them on board, and excited about it. So, yeah, you made mention of you have got some disparate systems, Allscripts, legacy MEDITECH, and looking into bringing some of that together. I think if you were to look back to the post go live, once you are through the project, and into operating optimization type of mode, what would you say? Hey, was that project completely worth it? You know, what are those things that that you're looking for? Would you look back as an organization and say, yep, all the challenges of an implementation, all the hard work, was worth it because of... what?

Falcone: I think it is going to be maybe three aspects, but really, when we set out to do this we wanted to make it easier to use. Patient safety — patient safety is one of my hot buttons. It is all about the patient and what are we doing to keep those patients safe. When you go from one platform to another platform, and you are not sure if your interfaces are working appropriately — that what goes in comes out the other side. That is critical to me. So ease of use and patient safety. Next is the ability to get the data that comes out of it. So, those are the three things that on the backside that I'm looking for.

Healthcare has changed in the last 30 years. Unfortunately, my EHR has not changed at the same pace as healthcare, and I think we have got to do more to get ourselves into today's current day and then do a better job of keeping it up to date as we continue through. But I think if I had to point to one, I would still point back to the patient's safety: by making processes easier, better communication, and reducing human entry where it does not have to be.

Sobol: You are spot on there. You touched on the technical aspect of the work that was required, just to lay the foundation to kick this project off. But maybe if you would not mind, tell us a little bit about how you know, aside from the technical aspects of it. How have you gotten the organization ready as a whole right?

Because everyone's engaged, everybody's involved from the leadership all the way down the chain. A change like this, a project like this, impacts everybody. So, maybe share with our listeners, how you have got the entire organization ready for this. Share some of your communication tips or creative ways that you have gotten folks bought in and then engaged on what needs to take place for the implementation.

Falcone: Well, I think keeping the communication out there regarding what we want to do, what we are working towards, getting folks to look at it, be hands on to say, wow, that is kind of cool. And even key staff members, even below the leadership level, have been very important in seeing it.

Sobol: Yes.

Falcone: And one of my physicians who helped design Allscripts on the clinic side years ago, is kind of coming along kicking and screaming. So, sending him to a site where it is up and running and getting his reluctant buy in, is huge on my clinic side.

Sobol: Sure.

Falcone: But we have had to engage in help because, as we look at the size of our organization, and I am going to design, get my drug library up, and make sure it talks to the ordering module and the nursing module. I have one pharmacist who staffs my hospital. So, looking to say who else will I have to use that pharmacist to help with the build, but how else can I do this with just one pharmacy and keep operations going in the same laboratory.

So, my real introduction to CereCore is getting some of that help on the ground has been an absolute requirement, because we never could undertake the project. And so, identifying folks out in our organization that can work with the key consultants, and then, of course, all the MEDITECH folks have given them a little bit at ease. But they are still anxious as our product is being delivered and we are going into the design phase.

Sobol: It is important to know that you are not alone.

Falcone: Yeah, that is exactly right.

Sobol: They have got people that they can lean on. Who has been there and done that. I think nobody has a crystal ball. There are always little things that pop up from time to time from an EHR implementation standpoint. But, with the decades of experience that you all have and certainly, from a CereCore perspective we have been in the MEDITECH implementation business for 30 years now.

I think collectively, we are in good hands on the projects and so you touched on a couple of these things. But I think one of the things that you made mention of again is communication as to the why.

Going back to the organization and back to the team as being so critical. And that is just not a one time deal. Right? That is at the beginning, it is in the middle, and it is at the end.

Falcone: Yeah, it is a way of life.

Sobol: It is one of those things where it is like, nope. Do you remember why? Oh, yeah, I remember why okay. Let's find those wins for each one of the lines of business leaders, for each one of those positions because yes, when there is ownership and previous system, sometimes it is a hard thing to bring them along. So, are there any other kind of keys to success that you all are tracking from that standpoint?

Falcone: No, you know, those are the major ones. I think looking back after this is done that you brought up number one, I think we will all feel like it is just giving birth and you do not want to go through it again for a long time. But my goal is to have my staff say, wow, this is a great tool. I keep telling them it is not going to be perfect, and you will have support when we go live. It is again, just keeping them with their eye on the ball, maybe. But I want them to be excited.

Sobol: Yes! Well, it is exciting, and it is scary, but I love your analogy because, as I was thinking about it and it is like giving birth. And, you know, as parents, we all know what that is like.

Yes, that whole process is hard, well harder on some than others. But then the work begins too. Right?

Falcone: Yes, that is exactly right.

Sobol: The baby does not raise itself. So, that work does continue. I think that is a great analogy that you bring up where it is like no, the work is not done. Now, you are on a platform that is going to meet the needs of the organization in the long term, but that is still going to require work. That is still going to require care and feeding. That's still going to require as things change inside of your organization, inside of your community, and tied to your service lines, et cetera. It will always require care to make sure that it is the best it can be for you going forward. So, thank you for bringing that up.

Falcone: Yeah, I think you must let them know our goal is to always be better. It will not be perfect, but them being able to give feedback on how to make it better is key.

Sobol: Yes.

Falcone: Understanding, yes, you might get frustrated tomorrow with this new system, and you want to throw it out the window, but I'd really love for you to constructively tell the right people, you can tell me, but I might not be the right one to get it fixed. It is the team in place has to be willing to listen to say, oh, yeah, we can fix that or, you know what it has to be this way and here's the why behind how it is.

And so, I think as an organization we are poised for it. I mean, the true test will be, of course, when we go live and everybody's freaking out that we have patients and if something is not working how they are used too.

Sobol: Yeah. Well, wonderful. Thank you very much for sharing a little bit about not only yourself, but your journey there, and providing our listeners some insights as it relates to starting the process of a new EHR journey.

So, are there any closing thoughts that you might have I always kind of just open it up at the end for any last words of wisdom for our listening audience and quite frankly it could be on, anything that we covered or anything that we did not cover today.

Falcone: Well, I appreciate the opportunity to talk through things. It is a self-realization to say, am I going down the right path or? Wow, does it cue something that I need to refocus some attention to. But I appreciate the opportunity to talk about it and share the kind of path that my team is on. And, it takes a whole village, and my village is moving. So, it is a nice thing.

Sobol: I think the more stories that we can bring to the masses, it raises all ships. Right?

Falcone: Right.

Sobol: And so, we are all at different points and different journeys, but at the same point, there are those common themes that we all deal with. And so, Lynn, again, thank you so much for sharing, taking time today, for your partnership over years, it means a lot to us. And we are excited about this journey with you all.

Falcone: Well, I am happy that you all are there to support us.

Sobol: Absolutely, well wonderful. Thank you.