Humboldt General Hospital's new CEO, Art Frable, has been on the job since Oct. 16. He hit the ground running, meeting department heads, staff and community members. He is listening to concerns and gathering information on the issues he is expected to take on.
"What I've done in every department is ask them to tell me their concerns. I ask, 'what do you need from me,'" Frable said. "My responsibility is to support people who provide the health care, who generate the bills, who take care for the building."
"I'm in the middle of all of that. I’m not a doctor. I don't generate the bills, I can't balance all the books. Everything I get done, I get done through somebody else."
He has no delusions about the difficulty of the job he's taken on. "There are a lot of challenges," he said plainly.
"I feel a tremendous sense of burden to live up to people's expectations."
"The public's concerns and the board members' concerns are real." Frable said. "There are some that are going to be a real challenge. There are so many things affecting health care that we don't control."
Outside influences include government regulations, insurance companies and the lack of compatibility between equipment and operating systems that are all crucial to providing health care while billing enough to continue to provide services.
Health care is a business unlike any other, Frable said.
He gave the example that when he was running a city-owned hospital he used to explain to city council members, "If you sell tires, you don't put the tires on the vehicle until you know how you will be paid for the tires. If you sell hamburgers, you don't hand over the burger until you've been paid for it. I can't do that in health care. I must provide the care that is needed whether or not someone is able to pay."
Medicare and Medicaid reimbursements concern every hospital in the US, Frable said. "Prior to the 80's, hospitals were paid by the government on the basis of what it cost them to provide care. Reimbursement schedules are now standardized for each type of care without regard for how much it costs to provide the care."
Frable said finances have to be a top priority at HGH whether he'd like that to be the case or not. It takes money to purchase state of the art equipment, money to attract and retain good doctors and nurses, money to provide the very best treatment, money to run the facility.
Frable said locals don't need to worry about him trying to continue to expand HGH. "You don't have to argue with me about that, that's not the agenda," he said. "The agenda is to take what we have and fill it."
"I think one of the worst things a hospital can do is have delusions of grandeur," he continued. "We need to deal with reality — we don't have the potential of being the Mayo, our first responsibility is to serve our community."
Another top priority will be attracting additional staff to HGH. That is a need common with most other hospitals. "Thankfully, Great Basin College (GBC) has the nursing program that has already been a great benefit to us and will continue to train top nurses," Frable said.
Frable is focusing on hiring the right people. He noted that a shortage of staff limits the number of people who can benefit from the beautiful facilities at HGH.
For instance, Harmony Manor Skilled Nursing Center and Quail Corner Memory Care Center are currently limited in the number of residents they can accept because more staff members are needed.
"We're only talking about three or four people — probably one nurse and three certified nursing assistants (CNAs,)" Frable said. "Our commitment is to serve our community. We get calls every day to take patients in for long term care from other places but our first priority is to have beds available for people in our community."
Frable has a career full of experience he wants to bring to bear on many of the issues facing HGH. He has plans to develop stronger cooperative relationships among rural health care entities. He noted his main strength is persistence.
"I'm working to get up to speed - to know the people and the issues. There are scores of contracts I need to know and understand, contracts up for renewal in November and December. Part of what’s on my agenda is to meet with individual board members on their concerns and issues."
Frable said his overwhelming impression of both the hospital and the community is very positive. He said he's been interested to meet a lot of great people who were raised here.
He's also been fascinated to see people who came to Winnemucca from places like South Carolina and Massachusetts. "It's fascinating to learn the variety of reasons why people came here. They have been some of the most positive people I've talked to; they stayed because of what they found here."
He and his wife like their new community, he said. There are things he's looking forward to doing in his free time, provided he finds any at a future point.
He likes the wide open spaces in Humboldt County. "I don't have a four-wheeler yet but I'm seriously considering getting one," he said.