Obenauer helps guide rural North Dakota hospital through tough times
Trustees of the Year 2008 - Winner: Small Healthcare Organizations
Shortly after her first, tumultuous, five-hour board meeting in 2003 at then-struggling Sakakawea Medical Center in Hazen, N.D., Christie Obenauer discovered she was pregnant with her third child.
Obenauer, 35, who also is a vice president at Union State Bank in the town, wasn’t sure she had the energy to stick with the hospital. She recalls, “A lot of nights you leave those long board meetings and go, ‘Why am I doing this? It is stressing me out.’ ”
She not only stayed but also became board president in 2006. “Knowing how important—because I grew up here and was born in the hospital—that organization is to the health of the community … I knew it was an important thing to be a part of.”
For her accomplishments, Obenauer has been chosen as the 2008 Trustee of the Year for small healthcare organizations—those with less than $75 million in annual revenue or fewer than 250 beds.
Indeed, her passion, commitment and boundless energy helped turn a stressed hospital into a prosperous one. “She is terrific,” says Tony Pfaff, a Modern Healthcare Up & Comer from 2000 who is chief executive officer of Cypress Health Systems, which has managed the hospital since 2004. “When I say she is energetic, that is truly an understatement. She spends a lot of time on hospital business,” he says.
The 25-bed Sakakawea Medical Center, which became a critical-access hospital in 2001, faced problems familiar to many rural institutions: It struggled to fill beds and implement standard procedures to control expenses and improve efficiency.
The hospital’s chief executive left shortly after Obenauer joined the board, leaving the hospital without a top executive for about six months. With a vacancy at the helm, board members spent hours addressing day-to-day management issues before hiring Cypress in May 2004. A permanent CEO, who also was a Cypress employee, came onboard in August 2004.
Cypress set up standard procedures to control expenses. For example, “There was no purchase-order system, and anybody could buy anything. We made the CEO responsible for that,” Pfaff says. Although the board opposed layoffs, management crafted procedures to limit overtime expenses as a way to control labor costs.
Tighter financial controls have paid off. While the hospital lost about $377,000 on net patient revenue of nearly $5 million in fiscal 2003, it earned nearly $370,000 on net patient revenue of $7.2 million in 2007.
Thanks to management’s turnaround plan, the hospital was fiscally healthy when Obenauer became board president in 2006, allowing her and the board more latitude to make decisions designed to grow revenue and improve services.
For example, Sakakawea took over management of two rural clinics—one in Hazen and one in neighboring Beulah—in July 2007 from 282-bed St. Alexius Medical Center in Bismarck. To minimize financial risk and still gain some local control, Sakakawea didn’t purchase the clinics, but rather leased them from St. Alexius. Some front-line providers—nurse practitioners, physician assistants and doctors—are still employees of St. Alexius and are included in the lease arrangement. However, other workers at the clinic, such as nurses, are now Sakakawea employees.
It was a stressful decision for the board, however, because Sakakawea had sold the very same clinics to St. Alexius in 2001.
“Some of our board members had been on the board when we had owned the clinics, and they were bleeding us … there was some hesitation,” Obenauer says. In the end, the desire to have local control over basic healthcare services overcame concern about the financial risk involved, she says.
Obenauer spearheaded creation of a new mission, vision and values statement as well as a strategic plan, completed in 2007, which the board plans to update regularly. The board last year also purchased a $400,000 computer system that includes an electronic health record and physician order-entry capabilities.
Says Obenauer, “We have managed to turn the corner and are heading in a really great direction.”
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