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Rural Healthcare Spotlight: Daniels County, Montana



If you looked up “rural county” in the dictionary, you just might find a map of Daniels County, Montana. With 1,661 residents spread across 1,426 square miles, Daniels was named the most rural county in the continental U.S. in 2000, according to the Index of Relative Rurality.


Surrounded by farmland that stretches to the horizon in every direction, Daniels Memorial Healthcare Center (DMHC) is a nonprofit, 25-bed Critical Access Hospital. As the second-largest employer in the county, DMHC enjoys strong community support and an active volunteer board, led by Paul Kanning, a fourth-generation farmer.


When Paul reached out to Rural Healthcare Initiative to ask about our pro bono board education services, we jumped at the chance to help.


Having just completed three separate educational sessions with the DMHC board, we asked Paul to tell us more about his community and the challenges and opportunities that he sees for the local hospital in “the most rural county in the continental U.S.”


RHI: You joined the Air Force to get away from Montana, but years later, you ended up back on the family farm. What is it that brought you back and keeps you planted there?


PK: There is so much that draws me to this area. I love the tight-knit community where everyone is a neighbor regardless of how far away they might reside. I love that my office is outside with a better view of nature than any building could ever provide. I love the constant learning in agriculture because two years are never the same. I love the technology we utilize, from remote sensors all the way to satellites. I love the country churches, the world-class hunting, the community orchestra, and the county fair. This community enriches me in every way I could ever want.


RHI: Your leadership skills have to be in high demand, but you’ve chosen to focus on DMHC. From economic development to quality of life, how important is it to have a strong, stable hospital in Daniels County?


PK: There are many essential services a community needs like a school, local government functions, churches, communication, etc. But the bedrock of all of those is the hospital. Without it, we wouldn’t have the people to fill those other vital roles. We need local emergency care rather than having to drive an extra 40 miles. We need support for grandparents to age in place so they don’t have to move away from their families. We need local clinical care and outpatient services so that a 20-minute appointment doesn’t require an additional 90 minutes of driving. We need child services such as immunizations, speech therapy, sports physicals, and well child checks so that young couples can begin their families. We need all the tertiary support the hospital provides such as transportation assistance, meals on wheels, and adult day care that would not otherwise be available. The hospital is the foundational cornerstone of our county.


When Paul reached out to Rural Healthcare Initiative to ask about our pro bono board education services, we jumped at the chance to help.

RHI: What are the biggest challenges that you face at DMHC, and how are you addressing them?


PK: I am amazed by our hospital leadership and the efforts they have undertaken to ensure DMHC prospers. We face staffing shortages like every hospital, so we focus on growing our own locally by engaging and partnering with the school district to promote healthcare-related careers. We recognize technology is transforming care, so we are embracing it through a virtual front door, new telehealth and telemed services, and multi-media outreach. We know future growth is in outpatient care, so we are pursuing construction of a new facility that will allow us to integrate those functions into our service lines. And we know in the not-too-distant future that reimbursement will be centered around community health rather than sick care, so we are instituting our own population health program as a first step in integrating social services referrals. It won’t be easy to accomplish all of our goals and we will have failures along the way. But we will learn, investigate, deliberate, persevere, and succeed.


RHI: Let’s talk about board leadership, in particular. When the population is well under 2,000, how do you recruit 10 folks and keep them engaged and up-to-date with all the intricacies of healthcare?


PK: First, we actually have an advantage in a rural setting because many of our neighbors, family, and friends served long before we came along. They succeeded as trustees and now we are accountable to them for ensuring it continues. They know healthcare governance, so they are able to ask the smart questions and guide us when we need it. They know it’s a difficult task, so they help in recommending and nominating trustees. That community engagement and community standard of success is an advantage.


Second, we invest time and funds in trustee education and training. We begin each meeting with a guest speaker on a healthcare or governance-related topic and we end each meeting with an additional 15 minutes of online trustee education. We participate in conferences every year, sending different trustees to the AHA Rural Healthcare Leadership Conference, our state hospital association conference, the Western Regional Trustee Symposium, and the Billings Clinic trustee conference. We have an annual board retreat to evaluate board effectiveness and efficiency. And separate from the annual management goals, we also develop annual board goals which include our plans and expectations for trustee development.


RHI: Finally, the vision statement for DMHC says that you want to be nationally recognized as a top 100 Critical Access Hospital. How are you doing on that goal?


PK: That goal stems from the first part of our vision which says we will be an oasis of health and healing. There are healthcare deserts forming around the nation and in our state. We aren’t going to allow that to happen here, not on our watch. And not only are we going to prevent a desert, we’re actually going to be an oasis. That means we need to be among the best in the nation.


How are we doing? We have come a long way and we have much further to go. When we started down this path, DMHC didn’t even merit a score from Chartis. We hadn’t even reached zero yet. Today we’re on the scoreboard at 59.3 and we are showing continual incremental improvements. The great thing is it requires every single person on the team to improve, advance, and evolve. It includes every floor, every corner, every process, and every patient. It won’t be fast and it won’t be easy to attain. We are going to get there though and I’m excited for that day when the rest of the nation learns DMHC truly is an oasis.


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Pro bono board education is at the heart of RHI's nonprofit mission, and anyone can apply online, as Paul Kanning did. If you believe your rural hospital would benefit from our free educational offerings, we encourage you to apply today.

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