Summer 2010 Quarterly Newsletter
CONTENTS:
Director's Column
Partner Focus
Community Focus
Special Feature
Profile
SUMMER
2010
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(PDF: 206KB/11pgs)
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DIRECTOR'S COLUMN
What, even more change?
Mark Schoenbaum
Last month’s 2010 Minnesota Rural Health Conference in Duluth was a
success by all reports. The conference theme was Leading Change for
Rural Health, and 480 rural health leaders attended from all over Minnesota.
As you can see from the conference theme, change remains central to our
lives in health care—what with state health reform, a major recession and
now federal health reform—so central that I sometimes feel I’m suffering
from change fatigue. But I felt recharged after the conference, which kicked
off with a very timely presentation on change itself by management
consultant Patricia Moten Marshall. Marshall laid out the ever-quickening
pace of change throughout our world and confirmed that we’re increasingly
hitting our “future shock” thresholds.
Marshall’s model of change builds on the work of noted social psychologist
Kurt Lewin. Both Marshall and Lewin understand that change is a process
that moves from the status quo through a period of stress and transition to a
settled future state. I like the analogy that the change process is similar to
stepping off the curb into traffic and making your way to the other side of the
street. It can be stressful out in the middle of the street until you land safely
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Summer 2010 Quarterly Newsletter
on the far side. You can find Marshall’s full presentation online (PDF: 18
pgs/202KB).
Conference presentations illustrated life in the rural health system at each
point along the continuum of change.
Mike Flicker of Lakeview Clinic in Sauk Centre shared his approach to
understanding the effect of the retail clinic trend on rural communities.
This trend is still on the horizon in most rural communities, and
Flicker is smart to stay ahead of this change.
Avera Health System’s e-Emergency effort began in October 2009,
with video connections and consultations from Sioux Falls to
emergency departments in 17 rural hospitals. This change is already
reducing patient transfers, supporting smaller emergency department
staff and generating revenue. These hospitals are in the midst of a
positive change and well on their way to establishing this new
approach.
Stratis Health reported on their project to support Minnesota’s Critical
Access Hospitals as they begin reporting quality of care information
under state health reform requirements this year. During this project,
72 hospital participants shared the time, knowledge and resource
challenges they’re experiencing as they begin this new era. Those
involved are definitely in the heart of this transition.
Riverwood Health Care Center and Cuyuna Regional Medical Center,
two neighboring northern Minnesota Critical Access Hospitals,
presented their approach to offering specialist services in their
communities. Together they’ve recruited and retained 16 specialty
physicians, an amazing accomplishment for two small hospitals.
They’ve built a stable future for their institutions and their
communities.
You can find these and all conference presentations online.
Patricia Moten Marshall characterized organizations that adapt effectively to
change as positive, focused, flexible, organized and proactive. Even in the
midst of major transition, these organizations focus on the future, let people
know they are capable of achieving the change, and give people the
resources to be successful. I left the Rural Health Conference ready to step
off the curb and out into the whirl of change, inspired by the hard work and
success stories I heard in Duluth.
Mark Schoenbaum is director of the Office of Rural Health and Primary
Care and can be reached at [email protected] or 651-2013859.
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PARTNER FOCUS
A few months ago, Flex coordinator Judy Bergh met with Brett Rima of Thief
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Summer 2010 Quarterly Newsletter
River Falls Area Ambulance. Brett showed Judy where AEDs purchased
with Flex funds had been placed around the community. Judy loved seeing
how far the Flex dollars were going; but hearing the enthusiasm in the
community for Thief River Falls Area Ambulance was the highlight of the
trip. Judy asked Brett to share details of their successful program.
THIEF RIVER FALLS AREA AMBULANCE PUTS HEART TO
HEART INTO ACTION
by Brett A. Rima, Operations Manager, Thief River Falls Area Ambulance
“An AED machine at our rural site
could mean saving an
employee’s life.” —Mike
Sorteberg, general manager,
Ericco Tool & Mfg
“I have seen the power of
Automatic External Defibrillators.
As the focal point of community
events, we are extremely grateful
to receive an AED.” —Shane
As part of an ongoing effort to support community projects, the Minnesota
Department of Health-Office of Rural Health and Primary Care awarded a
$25,000 Flex Grant to the Thief River Falls Area Ambulance. This award is
funding our “Heart to Heart” Program.
Our mission is to make our service area safer for families to live and work.
We also want to be a vital and integral part of the community—a resource—
not only seen when people are ill or injured. We are making extensive
efforts to enhance our relations within the community. It was through one of
our many outreach efforts that we learned that the community needed—and
lacked the funding to purchase—Automatic External Defibrillation (AED)
equipment.
Zutz, principal, Lincoln High
School
“Last year during a tournament, a
ballplayer was hit directly in the
chest while running to first base.
He fell immediately—not
breathing. A spectator
administered CPR and the child
was rushed to the ER for followup care. The cardiologist
recommended that an AED be
placed at the complex.”—
Madelyn Vigen, director,
Thief River Falls Parks &
Recreation
l to r: Rick Besser, supervisor of Thief River Falls Area Ambulance (TRFAA); Rev. Rick Lambert,
pastor, St. Bernard's Catholic Church; Madelyn Vigen, director, Thief River Falls Parks & Recreation;
Shane Zutz, principal, Lincoln High School; Brett Rima, operations manager, TRFAA
Thief River Falls Area Ambulance (TRFAA) operates three ambulances and
an Advanced Life Support emergency response vehicle. We provide
emergency 911 pre-hospital care and inter-facility transfers to the residents
of Thief River Falls, all of Pennington County, and parts of Beltrami and
Marshall counties. The primary service area encompasses 1,200 square
miles and a population of 12,000. Our ambulance response times are within
seven minutes to all parts of the city limits; however, the maximum one-way
response time is as much as 55 minutes in our extended response area. It
is imperative that early defibrillation is accessible to the public in areas of
delayed response. Collaboration
We worked with area businesses, churches and organizations to promote
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Summer 2010 Quarterly Newsletter
Heart to Heart, publicized it on the radio and in the newspaper. In addition,
ambulance staff visited public venues to explain the project benefits and
how it would enhance customer safety. We had great buy-in and the Heart
to Heart project placed AEDs in Pennington County areas that
accommodate high volumes of people on a regular basis like businesses,
industrial sites, schools, churches and places of recreation. Within 60 days
of receiving the grant funding, we provided AED training and placed devices
in Arctic Cat, Inc., Huck Olson Arena and the Multi-Event Center ball
diamonds complex, Hugos and MeritCare Northwest Medical Center.
Measuring success
We are using two methods to evaluate the project:
• The number of AEDs placed within the community and service area
• The number of classes taught, resulting in a cumulative number of
people trained in administering CPR. We will then compare and evaluate the save rate of victims of cardiac arrest
based upon those who experienced early defibrillation versus prolonged
defibrillation, or perhaps no defibrillation at all. Two years after initial
implementation of the project, we will collaborate with MeritCare Northwest
Medical Center to evaluate final outcomes of those patients who were
treated with defibrillation and transported by ambulance to the medical
center.
Quality service is of the utmost importance when dealing with patient care.
It is our goal as a public safety EMS provider to offer and deliver excellent
care to the citizens who count on us in times of emergencies, tragedies and
disasters. As part of the initial grant process, we have developed and
nurtured community relationships between the ambulance service and
businesses, schools, churches and government. Implementing the Heart to
Heart program in Pennington County not only educates the public on the
use of AEDs and CPR, but it also enhances the importance of Emergency
Medical Services within the community. top of page
COMMUNITY FOCUS
IMPROVING HEALTH OUTCOMES
By Brendan L. Ashby, Executive Director, Northeast Minnesota Area Health
Education Center
mnHEALTHnet is a program of the Northeast Minnesota Area Health
Education Center (NE MN AHEC). A collaborative interprofessional network
of health care, community and academic partners, mnHEALTHnet is
committed to supporting community organizations to develop chronic care
management/education and training resources for rural and underserved
communities. In 2008, the Northeast Minnesota AHEC and collaborating agencies,
including health care systems and academic institutions, received a Rural
Health Network Development Program planning grant from the Health
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Summer 2010 Quarterly Newsletter
Research and Services Administration (HRSA) to support network
development.
The goal for mnHEALTHnet is to strengthen the rural health care delivery
system at the community, regional and state level by supporting individual
members in the network to achieve improved health outcomes for rural and
underserved residents in northern Minnesota by:
• Promoting best interprofessional care practices
• Documenting improved health outcomes for chronic conditions, such as
diabetes and obesity, geriatric rehospitalization and palliative care initiatives
• Stimulating long-term partnerships among rural health care providers
• Providing education and training opportunities to support communitybased health professionals
• Recruiting and retaining health providers.
Benefits
mnHEALTHnet members benefit from streamlined and coordinated
communication among partners and increased access to resources not
otherwise accessible by individual entities. Some early successes include:
• Monthly dialogues to access specialized training and technology
resources, recruitment strategies and evaluation of interprofessional practice
efforts.
• A secure members-only collaboration site, which serves as a repository
for mnHEALTHnet activities, training events and reference materials. The
site is also a primary communication tool to share best practices and
lessons learned from the MN AHEC-funded interprofessional practice and
education projects.
• A membership to the National Cooperative of Health, linking members to
a national resource of health network initiatives.
• A $30,000 grant from the Otto Bremer Foundation that helped expand
the membership base to health systems in Aitkin, International Falls, Milaca
and Princeton.
• A partnership with the National Rural Health Resource Center that
supports interprofessional conferences on health information technology and
quality improvement.
• A partnership with the Minnesota Area Geriatric Education Center to
sponsor interprofessional geriatric/gerontology education remotely to
professionals, including physicians, nurses, pharmacists and occupational
therapists. Topics include geriatric medication therapy management,
geriatric nursing and geriatric mental and behavioral health.
Community Relationships
As community hospitals, most of which are designated critical access
hospitals, mnHEALTHnet members have close relationships with the
communities they serve. The community-based boards of directors are
composed significantly of local community members and are required to
engage community stakeholders in the planning of future initiatives through
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community meetings, patient surveys, requests for public comment and
strategic dialogue sessions.
mnHEALTHnet members
• Fairview Range Regional Health Services, Hibbing
• Gateway Clinic, Inc., Moose Lake
• Kanabec Hospital, Mora
• Lakewood Health System, Staples
• Mercy Hospital Health Care Center, Moose Lake
• Mille Lacs Health System, Mille Lacs
• Pine Medical Center, Sandstone
mnHEALTHnet partners • GlaxoSmithKline
• Minnesota Area Geriatric Education Center (MAGEC)
• National Rural Health Resource Center
• SISU Medical Systems
• University of Minnesota Academic Health Center
• U.S. Department of Health and Human Services Health Resources and
Services Administration
Financial Support
mnHEALTHnet receives financial support from the Health Resources and
Services Administration Office of Rural Health Policy, the Otto Bremer
Foundation and the University of Minnesota Academic Health Center.
For additional information on mnHEALTHnet, contact Brendan L. Ashby,
executive director of Northeast Minnesota AHEC, Hibbing, at 218-312-3009
or [email protected].
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SPECIAL FEATURE
RURAL VOICES: STEP UP. SPEAK OUT
By Kristen Tharaldson, M.P.H., Senior Planner, Minnesota Office of Rural Health
and Primary Care
I was picking out one more stocking stuffer for my niece, listening to Squirrel
Nut Zippers Christmas Caravan, and planning my drive up north to see the
family. It was December and I was also applying for a coveted spot in the
national Office of Rural Health Policy’s 2010 Rural Voices Leadership and
Policy Workshop.
Kristen Tharaldson
My catalyst for applying for the workshop was participating in three Health
Resources and Services Administration (HRSA) grant reviews last year.
Reading grant proposals from other regions of the United States piqued my
interest in the variation of rural health concerns. The lack of primary care,
mental health and oral health providers was shocking. The impact of
generational poverty and rural brain drain was extreme. I was hoping to
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connect to this bigger picture by meeting some new colleagues from other
states.
My application focused on my work as a senior planner in the Minnesota
Office of Rural Health and Primary Care, where I provide staff support for
the Rural Health Advisory Committee (RHAC). I see RHAC as a connector
for people and ideas. I see the work as essential to ensuring that rural
voices will be heard in ongoing statewide health care discussions, as well as
recent health care reform activities.
I was thrilled to be one of 24 people accepted into the March 29-31, 2010,
workshop in Washington, D.C. Participants were selected to reflect a
spectrum of leadership experience—from those with less opportunity to be a
leader to long-time rural leaders. Open only to Office of Rural Health Policy
(ORHP) grantees, the workshop included representation from the Black
Lung Clinics Program, Rural Hospital Flexibility Program (Flex), HRSA Rural
Health Outreach and Networking Grant Programs, and State Offices of
Rural Health (SORH). My application crossed two programs—Flex and
SORH.
There is rural…and then there is RURAL
Although I live and work in a metropolitan area, my roots are in rural
northwestern Minnesota. The challenges my family experienced seeking
quality and timely health care fuel my work and passion for rural health
issues. Between my personal history in a rural setting and traveling all over
Minnesota for work, I really thought I had a grasp of “rural.”
I learned differently! To get to the workshop, I walked a few blocks from my
condo to the light rail, took a direct flight, and four hours later I landed in
Washington, D.C. A workshop colleague from Alaska (where elk, deer and
bears are more common out her window than people) traveled for nearly
two full days. She took a ferry, puddle jumper plane, shuttle bus, plus two
additional flights to arrive in D.C. Definitely one of the most interesting parts
of Rural Voices was meeting the people!
Workshop events
On the first day, HRSA Administrator Mary Wakefield was a total inspiration.
We heard and believed her message, which was: ‘We need you in rural
health and we need you to be active!’ That was exciting for a lot of us to
hear. Until she asked us to filter ideas back to them, I would never have
thought to share ideas with the national office. It was a great call to action.
Tom Morris and his staff from the Office of Rural Health Policy made it clear
that the participants are seen as ORHP’s eyes and ears on the ground.
ORHP wants to know the concerns and accomplishments of rural health so
they can share them more broadly. Much of what we learned is that we
have to show up—we have to get to the table—and we also have to open
our mouths or rural can easily get left out. The leadership part is having the
confidence to add a unique viewpoint.
On the second day, we participated in eight hours of leadership training with
a very dynamic duo: Denise Denton and Denny O’Malley. Denton was the
first person to be employed by a state office of rural health (Colorado) and
is a former National Rural Health Association president (1992). Her
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husband, Denny O’Malley, is a former Critical Access Hospital administrator.
In addition to a focus on leadership styles, the class explored community
building—how to find and mobilize community assets. It wrapped up with
tips for facilitating effective meetings.
The last morning included sessions on engaging and collaborating with
stakeholders. We learned from rural advocates and health policy experts,
including a community health clinic administrator, a state office of rural
health director and representatives from the Centers for Medicare and
Medicaid Services and the National Council of State Legislatures. All of the
speakers were very passionate and emphasized a common message: to let
our voices be heard on rural health issues.
Rural Voices: Open your mouth
It felt good to be connected to the bigger picture. The experience changed
how I look at my work. Unless I am out there having conversations in rural
health settings, I won’t hear someone say:
“This is where we are vulnerable in our program.”
“I wish I knew someone I could consult with.”
“If only I had a simple little directory.”
I learned in the workshop to open my mouth—to be a rural voice—to say,
“here is a person you can talk with” or “here is tool you can use” or “we
don’t have anything for you now, but maybe we could make a
recommendation to address that.” Everything feels more hands on now and
is more concrete, less conceptual.
There was a lot enthusiasm in the workshop about the new opportunities
that health reform may create. Everyone came to the table with different
ideas of leadership and how we saw those opportunities. Some saw them at
the national level, some at the state level. We learned that leadership can
mean informing people locally, organizing constituents, or making
connections with the National Rural Health Association or Office of Rural
Health Policy. It ran the gamut. That was part of the excitement that
powered the workshop—the differences in approach to making sure RURAL
is always at the table.
Involvement in the Rural Voices Program helped me make connections
between people and innovative ideas and effective policymaking. National
Health Care Reform implies fundamental changes are occurring in health
care. Ongoing leadership is essential to make sure rural community-based
efforts are a part of the solution. I look forward to continuing to engage with
colleagues from broader rural communities on the health care issues of
today and tomorrow.
Kristen Tharaldson can be reached at [email protected] or
651-201-3863.
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RHAC MEMBER PROFILE
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Summer 2010 Quarterly Newsletter
ORHPC TALKS WITH RURAL HEALTH ADVISORY COMMITTEE
(RHAC) MEMBER YVONNE PRETTNER SOLON
Please explain your professional work to us . . .
I am a developmental psychologist by training. I practiced as a clinical
psychologist for 30 years, briefly at the Range Mental Health Center in
Aurora, Hibbing and Virginia. Then I found my professional home treating
both in-patients and out-patients at St Luke’s in Duluth for the last 25 years.
I have focused on adult issues, particularly survivors of abusive
relationships, PTSD and dissociative disorders. I also designed and ran an
eating disorder program.
Sen. Prettner Solon
When I reached 40, I knew that developmentally it was time for me to give
back to my community and I applied to various boards and commissions.
When I was not appointed, I ran for an at-large seat on the Duluth City
Council, thinking someone might remember me when the election was over
and appoint me to a board or commission. But, much to my surprise, I won
the election and served for 12 years. I was then appointed to several boards
and commissions—including today serving on the Duluth Graduate Medical
Education Council.
When I learned in 1999 that I had breast cancer, I planned to take a year off
from the Council and then run for mayor. However, after my own cancer
treatments, my husband, a state senator for 31 years, was diagnosed with
stage four malignant melanoma and died 10 months later. The day after his
funeral, 35 people arrived at my door asking that I run for my husband’s
Senate seat. I was grieving and knew I needed a cause to restore meaning
to my life. I agreed to run to complete the final year of his term.
After that first year, I considered running for mayor. But I was persuaded to
run for reelection to the Senate. With my health care background I
gravitated toward the Health and Human Services Budget Division
Subcommittee; and I have served on a host of committees, including the
Energy, Utilities, Technology and Communications Committee.
I’ve continued my clinical work throughout my Senate career. I’ve worked as
a psychological consultant on the oncology team. I have also performed
psychological evaluations on patients considering bariatric surgeries.
I like being in the Senate and love being instrumental in helping my
constituents. It is bittersweet to think about leaving. Should the Dayton
campaign prevail, I will serve as liaison between the governor and the
Legislature on health, energy and telecom issues. I will also establish a
senior citizen service center in the lieutenant governor’s office.
And your life away from work?
I have two adult children and one grandchild and they are the delight of my
life. My daughter is a registered nurse in Duluth and my son is a mortgage
broker in Golden Valley.
I love to travel and snorkel and I combine those interests every year in a
two-week vacation to Mexico. I enjoy small dinner parties with friends, and
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Summer 2010 Quarterly Newsletter
reading, walking and golfing. I golf every chance I get and it is never
enough.
What do you think are the most important issues facing rural
health?
There is a lot of disparity in public funding in greater Minnesota compared to
the metro area. Services are not as available and compensation is not as
equitable. I’m very concerned about the disruption in care when only four of
the 17 qualifying hospitals will be accepting General Assistance Medical
Care (GAMC). Not one is outside of the Twin Cities because of the
problems associated with disparity in service territories, risk and financial
liability. Consider how difficult it will be for people using GAMC to travel all
the way to the metro for services. That may change in September but it will
only be a fix until January. It is a problem now and it will be a problem then.
A related issue is transportation and the distances to specialty services,
chemical dependency and mental health services and pharmacies. I
recently authored and passed legislation to allow pharmacists to provide
medication management remotely through videoconferencing in cases of
chronic disorders for persons on multiple medications.
What do you think would make the most difference for rural
health?
I’d like to see more telemedicine to address provider shortages and at the
same time more loan forgiveness to encourage primary care physicians and
specialists to practice in rural communities.
The Rural Health Advisory Committee advises the commissioner of the Minnesota
Department of Health and other state agencies on rural issues; provides a systematic
and cohesive approach toward rural health issues; and encourages cooperation among
rural communities and providers. Meeting information is online.
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VIEW ONLINE ALL PREVIOUS ISSUES OF THE OFFICE OF RURAL HEALTH AND PRIMARY CARE PUBLICATIONS.
Minnesota Office of Rural Health and Primary Care
P. O. Box 64882
St. Paul, Minnesota 55164-0882
Phone 651-201-3838
Toll free in Minnesota 800-366-5424
Fax: 651-201-3830
TDD: 651-201-5797
www.health.state.mn.us/divs/orhpc
MISSION: To promote access to quality health care for rural and underserved urban
Minnesotans. From our unique position within state government, we work as partners with
communities, providers, policymakers and other organizations. Together, we develop
innovative approaches and tailor our tools and resources to the diverse populations we
serve
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