An interview with CEO John Henderson*
By Brant Couch

Brant Couch (BC): Why has Childress been able to succeed despite an increasingly complex and challenging economic, regulatory, and political environment?

John Henderson (JH): I think it is because we do our best work in difficult times… and we have a solid foundation. We are independent and I expect we will remain that way. We have a good combination of leadership with a vision and the determination to help everyone involved believe our best days are still ahead. This belief fosters inventiveness and new ways to meet human need. Even though it’s not getting any easier to improve quality, patient satisfaction, and control cost, we have managed to do so without going to the brink of financial failure.

BC: What are the most significant challenges ahead for CMRC and rural hospitals in general?

JH: Childress County is one of the poorest counties in Texas; we do not have oil and gas, just cotton and wheat fields. We are not heavily subsidized because we do not have property taxes. Also, the ACO (Affordable Care Act) cut Medicare payments to hospitals in anticipation of more insured patients. This did not happen: we took the cuts but did not get the coverage.

Small hospitals are most vulnerable. Everyone expects rural hospitals to close and I think there have been eight closures [in Texas] in the past 2 years. As things continue to deteriorate we have to remember it is always darkest before the dawn. Access to care is critical so a solution must be found.

While there are problems with ACO, I remain positive and optimistic. We are caring for everyone who is here, so I love the idea of moving from volume to value as we stand to benefit because our quality is great.

BC: How does cancer care fit into your survival plans?

JH: Everyone has been touched by cancer and this human need is the impetus driving our cancer program. Childress has always dreamt of providing limited chemotherapy service to patients and it finally happened about 18 months ago.
The biggest problem was finding a willing oncologist; it was hard to convince someone to drive for a half of a day to spend the other half of a day in the clinic.

I swung and missed many times… I approached oncologists in Altus, Wichita, and others until I found our partners in Lubbock.

By example, we went through a situation similar to our cancer clinic with a local dialysis center. They were for profit and were losing money so they did not renew their lease. But somehow, we figured out how to keep the service in Childress.

I believe ours is an interesting, valid approach for rural hospitals. Even though it is not a financially viable business proposition, because we are a public, hospital, we are able to do some things despite budget head wind. That said, our board has to stay in the neighborhood of breaking even.

BC: When it comes to surviving, what do you focus on?

JH: Our front office squeezes every dollar. Going forward, reimbursement issues will be huge and we have less control there, but we can hold the line with spending.

On the operational side, we will deliver great care and I hope the transition from volume to value will be quick.

Transparency is also vital; for the last 5 – 10 years we have intentionally measured and publicly reported more – rather than less (quality and satisfaction scoring). We are as transparent as possible and when we have had problems with data, we address the problem… we are not hiding the data.

Surgical site infections are a good example. When you have a sample size of five patients and one suffers congestive heart failure, it looks very bad. Large hospitals aim for 97% and because they treat hundreds of patients, the numbers are acceptable. But that doesn’t work for us so we stopped making excuses and we are doing everything possible to make sure we are always five for five.

BC: Looking ahead, what do you think the future has in store for your hospital?

JH: I believe our best days are ahead. For Childress, I do not see a lot of new service expansion. For the next 5 – 10 years we will hold on to what we have and focus on improving quality.

I think physician recruitment is going to be a big issue as well as nurse staffing. Work force issues have always been a challenge for small community hospitals.

But I do think the financial picture will start to improve in the next four to five years. If the national economy grows, it will contribute to our ability to survive… if it doesn’t, well we will see more closings. I hate to say it but it may take more closing to get the attention and action we need.

Overall, I believe clinical quality and a focus on patients is what makes hospitals like ours stronger. I know we will find a way. People underestimate the resilience and commitment that rural hospitals and communities have. We are going to be OK.

* Many Rural healthcare leaders see John Henderson as the spokesperson for rural healthcare. A testament to his leadership and the respect the community has for him is his selection as chairman of the Texas Hospital Association in 2016. John is the youngest person ever and the first rural CEO in 30 years to hold this position.