CEO bullish on future of North Big Horn Hospital

A very upbeat North Big Horn Hospital CEO Eric Connell provided a detailed progress report on the hospital, care center and the district in general to members of the Lovell Area Chamber of Commerce during the December 15 chamber general membership meeting at the Mustang Café.

Connell began by providing some perspective on rural hospitals across the nation compared to North Big Horn, with many communities losing their hospital due to Medicaid cuts or other factors.

“It’s really easy to fall into kind of a victim mentality, but we’re not doing that here,” he said. “Let me read a couple headlines to scare you. ‘Across the U.S., the rural health safety net remains under intense pressure. Over the last year, 18 rural hospitals closed or converted to an operating model that excludes inpatient care. That means, since 2010, 182 hospitals have closed -- rural hospitals. According to this new analysis, 46% of rural hospitals have negative operating margins, and 432 are vulnerable to closure.’

“So there you go. We’re not one of those.”

He then gave a personal story of his great-grandmother, Zitelle Hellstrom, working for Bellevue Hospital in New York City and held up a photo of her on the nursing staff in 1918. She married Charles Nephi Shumway and moved to Lovell in the 1920s and worked at the hospital that is now the Cattlemen Motel in town.

Pointing out an aspect of the photo, which hangs in his office, he added, “In a time of conformity in 1918, she was a bit of a maverick herself. I think we’re doing some fun things here.”

He noted two “maverick” hospital board members in the room, Bruce Morrison and Dave Winterholler, who he said are willing to push the envelope for progress, and he also introduced members of his leadership team.

“Our vision is that we want to be the top-quality healthcare provider in the Big Horn Basin and the region, and that idea -- the region -- is a new addition to our vision,” Connell said. “Our board of directors, over the last year, has seen that, not only can we provide great care to our community, to Lovell, Cowley, Byron, Deaver or Frannie -- the taxing district that is our hospital district -- this is also a magnet for people that want high quality care, and so we’re seeing in many of our services patients flocking to Lovell from great distances.

“That’s exciting for us. When we say we want to be the top-quality healthcare provider serving the Big Horn Basin and the region, I have my own personal vision statement that I add to the back of that, and that is ‘for generations to come.’ I think about my great-grandma, what it means to be in healthcare. It’s a service. It’s greatly needed, and I think about my own career journey and the journey of many of our team members. It’s meaningful work, and if we take good care of it and allow it to grow and flourish, then it’ll be here for the next generation.”

Part of helping the Lovell area thrive as a community is having a vibrant medical community, Connell said, and he said about 20 percent of Lovell’s gross domestic product is healthcare services, which will be even more important as baby boomers continue to retire. And so while many rural hospitals are closing as they face cost and staffing challenges, the highest quality facilities will thrive and be around well into the future.

“There’s a lot of pressure, but we feel like we’re putting our organization in a position to represent our community and do that into the future,” he said.

At the state level, Connell said, Wyoming’s hospitals and nursing homes provide just over $1 billion in employee compensation annually, provide $2.56 billion in impact to the economy and support more than 32,000 jobs. The facilities also create more than $79 million in state tax revenue and $520 million in county, state and federal taxes combined, according to a University of Wyoming and Wyoming Hospital Association analysis in January of 2023.

Five-year plan

Connell presented the hospital district’s five-year plan the board and leadership created in 2024, which included team, quality, safety, guest, finance and growth pillars.

Addressing the team pillar first – “our people and our employee engagement, satisfaction and loyalty” – Connell said the district performs an annual employee engagement survey, with options like, “I’m satisfied with my job. I would recommend my organization to friends as a good place to work. I see my profession in a positive light and encourage others to consider it a career.”

“Our aspiration is to be among the top 20 hospitals in the country that get measured,” Connell said. “And so that would put us in about the top 5%, about the 95th percentile, and we’re making progress toward that. Back in 2022 we were about the 76th percentile. Now we’re about the 89th percentile, so we’ve got about six more percentage points to go to reach that target. Kirsten Bryson is our HR leader. She’s here today and does a great job.

“We have a loyal workforce. It’s amazing. We have some employees that have worked in our organization 20 and 30 and 40 years. We couldn’t do it without many of them and the institutional knowledge that they have. And so over the next couple of years we’re really going to be focused on what do we do? How do we bring up the next generation of people that are going to help run this hospital and make sure that we can continue to provide that care?”

Looking at the quality pillar, Connell noted the recent Chartis Performance Leadership Award for the hospital.

“We’ve been receiving those top 100 awards for the last couple of years,” he said. “Back in 2024 we were a top 20 hospital in quality in specific area of practice (quality and outcomes), and where we want to get to is to be a top 20 hospital overall. So when all the metrics, not just quality but quality and finance and patient outcomes and patient experience are put together, we would like to be a top 20 hospital and do that consistently, not be a one-hit wonder. Year after year, we want to continue to make that progress and compare very favorably against other critical access hospitals and rural hospitals.”

The numbers are high, Connell said.

“At the moment, we’re about the 95th percentile as an organization. … The benchmark to be among that top 20, and in this case that usually hovers around the 98th percentile. So we’re in range. About the 95th percentile typically qualifies for top 100 status. We will know in February; that’s when they will announce top 100 and top 20.”

Turning to the guests pillar – patients, residents and families – Connell said the board and leadership team has set a high bar for guest satisfaction

“We have an aspiration as an organization,” he said. “We want people to recommend us 100% of the time, so we survey on that. It’s a tall aspiration. It’s very hard to please everybody 100% of the time, but we’re not going to set the bar at 98%, because then that means there’s two people (out of 100 unsatisfied). We’re currently running about 96%. So we still have work to do, and it may be an aspiration that carries on beyond 2029, but we will continue to work on that.”

Satisfaction high

Connell displayed a guest satisfaction graphic comparing the North Big Horn Hospital District to other medical organizations in the region, and North Big Horn had by far the highest number of deep blue – highest quality – responses from 10 questions surveying areas from nurse and doctor communication to the quality of care and room conditions.

He recounted a recent Google review from a woman that read, “I typically have no desire to be anywhere near a hospital, but they’re so wonderful over there I almost want to be deliberately hospitalized at NBHHD. They have a nice, clean facility and absolutely top-notch care. Between having a family member on swing-bed to emergency care, I have been nothing short of impressed and immensely thankful for the crew. This is, for sure, the best care you can get in the Big Horn Basin; absolutely nothing else in the basin comes even remotely close.”

As for the finance pillar, Connell noted the great work of CFO Darcy Robertson and said the district has gone from an operating loss of $667,000 in 2018, made up by the local mill levy voters support, to operating in the black by at least a small margin.

“This last fiscal year that just ended in July was the first year, at least since 2018 and probably well before 2018, that the organization had a slight positive operating margin,” Connell said. “And so what that means is that the revenue that comes in from insurance companies and patients for the services that we’ve been providing covers those expenses of providing the care. And why is that important? Well, it allows us to have a margin. It’s really important that there’s at least a small margin. The mill levy supports us so that if we can just break even on the services that we provide, just cover our costs, that mill levy will go a long way toward us being able to reinvest in things that are not as sexy (like carpet or a new boiler) that need to happen in order for us to continue to provide services.

“That’s due to us creating that magnet where patients are choosing to come to us from outlying areas. Now that we’ve been able to offer some services that patients are more accustomed to traveling for, like surgeries, they’re choosing to come here. And that’s pretty amazing. We have an operating margin currently of about $400,000, so we’re on track. Our budget is just $100,000 for operating margin, so it’s just slightly positive.”

And finally addressing the growth pillar, Connell said the district set a goal to double the number of “lives touched” by the hospital district and has done so. And it’s not just quality but also offering more services and interacting with the community from school talks to the Share-a-Stocking program.

“Right now we have about 30,000 touch points in our organization per year, so 30,000 times we have somebody who interacts with our organization as a patient. And it’s pretty impressive,” Connell said.

Finance and growth

Connell noted that about 60 cents out of every dollar in the district expense budget goes to the district’s 270 employees and that annual salaries and benefits total around $19.2 million.

As for facilities, once the district got through the COVID pandemic, even thrived through careful financial management, the district was able to repair the leaking care center patio, remodel and expand the emergency department and enact a management partnership with 13 nursing homes around the state, an effort currently managed by former CEO Rick Schroeder. The district had earlier expanded and remodeled the clinic.

Projects in the pipeline include adding six clinic exam rooms in “shell” space the board provided for when the clinic was remodeled and a new “bistro” in the hospital for better food service.

The district has expanded in-house specialists in the areas of cardiology, orthopedics, oncology and psychology and has started a new in-house sleep lab. Connell also praised the board for being willing to add services like the robotic surgery that was added last year.

“Just look at towns that have 2,000 people and look at the healthcare services that they provide,” Connell said. “I challenge you to find another one that’s as sophisticated and well regarded. There isn’t one. If you find it, show it to me. I’d like to talk to that person.

“There are a lot of factors that allow us to have a thriving, sustainable healthcare organization here. Part of that is we’re not so remote and so isolated. We’re actually close enough to where people are making a choice about their health care. People who live in Powell and Cody and Thermopolis and Worland and Basin, they all have a choice. If we were on an island 100 miles away from anything and there were 3,000 people, we wouldn’t be able to do many of the things that we’re doing today.

“I’ve told my team this: There’s not a better CEO job to be had in a smaller community in the country. I believe that that’s why I’m here. There’s nothing that beats this in terms of strategy, like whether there is going to be a hospital that thrives and survives into the future. I think this is the place for those reasons. But then when you add that the economics are favorable for us, and we’ve got really great people, that’s what makes the difference, really, in whether a hospital succeeds or doesn’t succeed. So when you put all those things together, it’s a great recipe.”

Connell concluded thanking the community for supporting the hospital and care center and urged people to support other institutions in town like the Hyart Theatre and local businesses.

“If we want to keep those resources, we’ve got to use them,” he said. “So whether that’s the grocery store, whether it’s the movie theater or local businesses, it’s so vital and important, because there are people that come from out of town and they make a judgment call on whether they want to live here and move their family here. And so the more that we can do to support whatever is local, that will help us thrive into the future.”