Since the start of my internship, I have already experienced so much about health administration from a rural health perspective and have had the opportunity to be involved with some amazing projects that assist the county’s rural population.

My internship is located in Cocke County, Tennessee with Rural Medical Services, Inc (RMS).  RMS has clinical centers located in both Cocke and Jefferson County and serves the surrounding counties.  While the Appalachian region, which RMS serves, is rich in cultural heritage and traditions, it is also often plagued by high levels of poverty and low levels of education.  In April 2010, the Newport Micropolitan Area reported 2,190 people unemployed resulting in a 13.4% unemployment rate, down from the March unemployment rate of 15.7%. According to the most recent estimates from the State of Tennessee, Cocke County has an average high school graduation rate of 61.2%, under the state average of 75.9%; Cocke County also has only 6.2% of the population that holds a Bachelor’s degree or higher.  Cocke County has  a population o 7,426 of 20.6% of its population is below the poverty level.  

My first day at Rural Medical Services (RMS), I was able to attend the both the monthly staff meeting and the Board of Directors meeting.  The staff meeting included all providers from each of RMS’s five clinical centers, along with the CEO, CFO, Operations Director, and the Human Resources Director.  Although RMS is a health system, the clinics are run with an element of autonomy at each center (the CEO jokes that he calls each center his “little fiefdoms”).    In addition to clinical responsibilities, providers are charged with the administration of their clinics.  Reports were given from the Medical Director, the CEO, CFO, and Operations Director.  Following these reports, a roundtable type discussion was held that let each provider from each center discuss any topics with which they were concerned.  An interesting topic that was discussed at the meeting was the passage of the new health care reform bill.  The CEO, as well as other providers, voiced concerns about the impact to their patient population as a results of the bill’s passage.  RMS experienced decreases in patient population with the changes in TennCare, RMS  and is concerned about the effect this bill may have on their patients.   It was stressed that RMS must continue to strive to be patient friendly.

The Board of Directors consists of two representatives from the patient population from each center, the CEO, CFO, Human Resources Director, and the Operations Director.  The Board meeting is run similarly to the staff meeting, but in a more formal matter with a call to order, motions, quorum, etc.  At the first Board meeting, provider patient-visit goals were discussed as well as the bid process for remodeling the Newport Center. It was interesting to learn about the bid solicitation process RMS must go through in order to remodel a facility. 

Another interesting administrative aspect that I was able to participate in was the walk-through of the Chestnut Hill Center remodeling project.  The Chestnut Hill Center is located in Jefferson County, TN across from Bush Brothers, Inc.  In May 2010, Bush Brothers, Inc. bought the facility that housed both the RMS Corporate Office and the Chestnut Hill Center.  As part of this purchase, Bush Brothers offered to relocated the clinic to an old school house located approximately half a mile down the road from the current RMS facility.  Bush Brothers, Inc.  agreed to pay for renovation of the old school to convert it into a brand new health center facility for the patients of the Chestnut Hill.  The new center will contain 7 examination rooms, a nurse’s station, 3 doctor/provider offices and lounge, a clinical laboratory, patient waiting room, billing center, and a procedure room.  RMS will lease the building from Bush Brothers, and Bush Brothers (in addition to paying for the renovations) has forgiven the first year lease payments for the facility.  RMS and Bush Brothers has a long standing relationship in the community and Bush Brothers viewed this remodeling project as a way to give back to the residents of the Chestnut Hill community.

The second week of my internship included helping with the annual RMS Health Fair held at the Lincoln Ave Baptist Church in Newport, TN and La Gran Commision Baptist Church in Morristown, TN.  These health fairs bring a number of services to the community that they would not otherwise have access to such as lab work, physical exams, pap smears, prostate exams, mammograms, eye exams, bone density scans, spinal screenings, and hearing exams in addition to health resources from other area organizations.  All these services are provided free of cost to the community!  Although the fair didn’t start until 9am, many people were waiting in line as early as 6 am to make sure that they could be seen and it was apparent that many of these people relied on this health fair to receive their health care. 

My main project for the summer is to conduct both patient and employee satisfaction surveys.  The patient survey asks a variety of questions to determine the overall patient satisfaction with both their respective clinical center and the RMS system as a whole.  For example, one question asks patients to assess the level of satisfaction of the centers was “Please rate the treatment received at this facility.”  Patients completing the survey rate their level of satisfaction on a scale of one to five, with one being very satisfied and five being very dissatisfied.
           

I have been collecting the surveys periodically since the start of my internship, but the final collection date will be July 1, 2010.  I will record and analyze all the data and will present my findings to both RMS staff and the Board of Directors in a PowerPoint format.  I will also include an analysis of the rating percentages for each facility on a separate handout sheet.  The purpose of this survey is to help the community by showing RMS and the centers what the patient population perceives as most important and will in turn to use this input to identify and implement quality improvement initiatives.

The employee survey is set up in a similar manner, with the goal of the survey being to assess the employee satisfaction at RMS.  I will begin collecting and inputting this data during the week of June 27^th, 2010 for a presentation to the staff and Board of Directors at their monthly meeting.  I think that this employee survey will be extremely beneficial to RMS because they have never done an employee survey and it will provide a good indication of the overall morale of the staff. I am anxious to see how my presentation of the survey results to the staff and Board of Directors will be accepted.  I hope the results will encourage staff and providers reevaluate reconsider how things are running administratively within their center.