Becoming a Textbook Turn-Around Story with Ashley Pool

Ashley Pool: It was the holidays. They thought they were not going to have a job at Christmas when their babies needed gifts. When I think about that, it just is so touching to me because I can't imagine being in that position. Thank God I've never had to experience that. And I just can't imagine thinking that I would not be able to provide for my family. And they stuck through it in spite of all of that.

Host: That's the voice of Ashley Pool, the chief operating officer of Lakeland Hospital. Just a year ago, Lakeland was on the verge of closing despite the essential care it provides to area residents. In this episode, Ashley walks us through the challenges facing keeping a rural hospital afloat in a time when it's increasingly more difficult to turn a profit.

Ashley: We will be the textbook example that all business schools use for how to save a rural hospital, because there aren't any examples out there right now. So to be able to take one and it be on the brink, and to be completely turned around like this hospital has, it will go down in textbooks.

Host: This is Health IT on the Record, presented by MEDHOST, a show that dives into how innovations and health information technology impact every aspect of a health system, from multi-hospital networks down to individual patients. In just a moment, you'll hear Ashley discuss her love for Lakeland and how that love has inspired her to fight for its employees and patients. Enjoy the conversation.

Ashley: Hello. My name is Ashley Poole. I'm the chief operating officer at Lakeland Community Hospital. I've been here since September 6th, 2018. I came on board almost a year after Lakeland was told they were closing. They actually became acquired by the healthcare authority in April of 2018. I believe that's correct.

Host: Right. In a moment, we'll talk about your journey here and what the ride has been. But before we get to that, can you just kind of walk through what were some of the things that led you to this time in your life?

Ashley: Sure. I became a nurse in 1998 and worked for five years at Huntsville Hospital in CCU. After that, I became a nurse practitioner, worked in various roles, owned my own practice,  went back to school to get a Master's in Management from Vanderbilt later. So I had worked as a nurse for over 20 years and had been a nurse practitioner for 16 years.

That's where I met Martha McCormick who was CEO of our hospital here, interim CEO. And she's also the COO of Java. So when Java Medical Group became involved in saving the hospital, being from Tennessee, logistically, it's very difficult for Martha and Bappa to be here onsite full-time. So Martha had called me and asked if I knew of anyone who might be interested in a position here full-time to help with some of the oversight with operations.

And so I thought about it and spoke to my husband, and I told her, "I would be interested." And she said, "Well, would you mind to come down and interview." So I said, "Sure. I'll come down and interview." So I came down and met with Bappa and Martha and met some of the people and just absolutely fell in love with Lakeland. The mayor came, and I met with him, and just met with so many people and realized there's no way I could not, given the opportunity if they chose me, to take this position, there's no way I could not take the opportunity.

Host: Yeah. How could you say no?

Ashley: Right. How could I say no?

Host: Now, when you think back to some of those stories, and I know there's a lot, and I'm putting you on the spot here. But is there one or two that just makes you think, "Wow." When you really reflect back on that, was there a story or two when you knew, "This is really a place I want to be."

Ashley: Sure. I mean, there's so many for sure. The ones that really stood out in my mind, initially, to hear the stories of employees who worked days on end to keep the hospital open. Because there were many who left. I mean, no fault of their own because they were the breadwinners of their family or whatever, they were told the hospital was closing. And up until the last moment, it really was set to close. And so you can't blame people for making those decisions.

So there were a lot of people who stayed and worked day and night. Literally, spent the night in the hospital to keep patients from having to go without care. So that's really going above and beyond. And then you've had people who've worked here, like Diane Caldwell, who's 49 years. Tim Robertson who's been here, I think, 36 years. You have the longevity of employees and the loyalty and commitment that I had not experienced in other places. And when you see that dedication and commitment from employees, to me, it was just phenomenal.

Host: You said you owned your own practice.

Ashley: I did.

Host: Twenty years in this, and the people really, in Haleyville, really different.

Ashley: Very much a family here. Very much a family.

Host: So how does that family, that feeling you get when you talk about that – it sounds so wonderful. How does that translate to more of your role, more of the business side of things? The financials, the business. You have to be profitable to make it a sustainable operation. So how does that translate? Does that translate?

Ashley: It does translate. And to me, as the operations officer, when I go to them and I ask them to look at things in a different way, they're not sitting there saying to me, "But we've always done it this way." They lived through that reality of, "The way we've always done it almost closed this place." And so rural healthcare, because we did not Medicaid-expand in Alabama – and I'm not saying that we should have, I'm just saying that it didn't happen – it really changed the landscape of rural healthcare for a lot of states. And it certainly did ours. And so because of that, we have to look at it completely differently.

And that means that we have to be very cost-conscious in the way that we approach our delivery of healthcare. And so when I go to them and ask them for their own ideas and their own just, "How do you think we should do this? What's your ideas on how we should deliver this care model?" They're all in, and they're brainstorming, and they're thinking of ways we can do this better and different and new. And they're not clinging onto those old ways.

Host: Before we jump into some of the biggest challenges that you face as COO, chief operating officer, here in a rural hospital, one other thing I definitely want to just have you paint a picture on is when you did learn about what the team went through before they were in this unknown around Christmastime, can you take me back to that? And I think that might tee up some of the motivation you had really joining here, helping make things sustainable moving forward.

Ashley: Well, I mean, let's face it. Any time you're in a leadership position, there are moments when you feel discouraged. As a leader, you feel like you're not getting enough wind, you're not getting enough funding, you're not getting enough raises, you're not getting enough machines, you're not getting enough whatever for – I mean, you just fill in the blank for the employees. You're just not getting enough. And so there's days that I would go home and just feel like, "I'm not enough for this place. They deserve more."

And so I was on Facebook looking back over the Lakeland Facebook page because we were going to revamp it. And our big push is community involvement and really being out in the community and trying to show them, "We're here. We're their new Lakeland. We're back. We're what they need, and we want to be here for them." And I came across this picture. And I get so emotional about it. And it said, "All we want for Christmas is for Lakeland to stay open." And so I took a screenshot of it, and I keep it on my phone now. So it's one of my little screensavers.

But to remind me of that's why, every day, I come to work. That's why I fight for the funding. I fight for the money. I fight for the employees. I fight for their raises. I fight for their reason to come into work every day. I fight for what they went through a year ago, for the seven 12s that they worked, for spending the night in the hospital, for – I've never had to do that.

Host: This is the holidays, too, we're talking, right?

Ashley: It was the holidays. They thought they were not going to have a job at Christmas when their babies needed gifts. My babies had gifts. I had a job. They didn't think they were going to have one. And when I think about that, it just is so touching to me because I can't imagine being in that position. Thank God I've never had to experience that. And I just can't imagine thinking that I would not be able to provide for my family. And they stuck through it in spite of all of that.

Host: Health IT On the Record is brought to you by MEDHOST. With over 30 years of experience partnering with providers nationwide, MEDHOST is helping evolve better solutions for healthcare and management through innovative workflows and technologies. For more information, visit www.medhost.com. Let's jump back in.

Host: It's exciting to hear this motivation, that fire that you have to go to work every day and work for the funding and work for the team, work for the employees. All these things. So this kind of transitions us, next, to talk about some challenges. And hopefully, other rural hospitals can kind of gain insight from your experience here. But in no particular order, just let's go through one, two, maybe three different challenges that you've experienced here. And kind of some ways that you've been combating that.

Ashley: Sure. One of the biggest things is, I would say, funding. So looking for grants in rural areas is an opportunity, for sure. And being in Haleyville, we are in a rural area. It is deemed rural by the government. So we are looking at government grants. Well, we actually have been awarded one. We've just been awarded one through UAB. We will have telemedicine. And that's going to be huge. We'll have neurology and behavioral health. So we'll have that available beginning in December of this year. And that's huge. So we're very excited about that.

Also, we did lower our bed count in September of this year to 49 beds, which puts us at an advantage for funding. So that's been huge. So there's things that we have been able to do as initiatives to better position ourselves for immediate funding that we needed to help the hospital stay open. Those are certainly challenges though.

And truly, I hope and pray that when all of this is done, that we will be the textbook example that all business schools use for how to save a rural hospital. Because there aren't any examples out there right now. Rural hospitals typically close. So to be able to take one and it being on the brink, and to be completely turned around like this hospital has, it will go down in textbooks.

Host: I think so. And we were talking to the mayor earlier today, and he was telling us – different people, he was saying, "Yeah. You might be able to do this in eight, nine months maybe." But he had six to eight weeks.

Ashley: Right.

Host: Right. So I've heard you talk before a little bit about  – it's just a challenge to have any profit in managing hospitals in the state. And that, combined with – earlier on today, we also heard, "Operating a rural hospital right now is challenging." So you're speaking to funding. You're speaking to really thinking through the strategy to be viable in rural healthcare. Earlier, you talked about people, employees. Walk me through just the things that you're thinking about as it relates to things like just your physician recruitment.

Ashley: Sure. We have several local physicians who do live here. They are mostly our primary care physicians. What we struggle with are mostly specialties. So they are our orthopedics, cardiologists, neurologists, psychiatrists. These are really high-level needs that our residents need here. It is so difficult to recruit that end because you don't typically have that level of care in a rural community. So what we find is that we have to recruit outside of our, what I would consider, a reasonable area of someone to be expected to drive every day.

So what we typically have is someone come one day a week. And that works pretty well. But what really happens is our residents drive to those places. So they're driving an hour and a half to a specialist. And that's a lot to ask of a sick person, truly. So those are some serious issues. And as we work through telemedicine and that becomes more of an accepted type of care, and when I say accepted, I mean insurance will actually pay for it, then we're going to be better in that area. But we have to get insurance on board because patients can't pay out-of-pocket typically for something like that.

Host: Let's now look within these four walls of the hospital, just your team. And clearly, they are really motivated and loyal, and there's a good culture here. So I would love to talk a little bit about just kind of building on that momentum. And some of the things that you've seen, what's worked, and what you want to definitely keep doing.

Ashley: I think the employees feel better since we're this far out from the near closure. I think they are still nervous at times.

Host: How do you know that?

Ashley: They say it. I mean, they talk about it.

Host: You're listening.

Ashley: Yes. I mean, thankfully, they talk very openly.

Host: That's part of the culture that the team has here, right?

Ashley: It is. It is very much part of the culture.

Host: And you'd rather here those things.

Ashley: I am so grateful that it's open and that they feel comfortable enough to discuss it. Because if you don't talk about those things, then those things become rumors. And rumors become very scary ideas. And so the fact that they're willing to come and say, "I'm worried about this. Is this true?"

When you've been through something that frightening, then what's to say that it couldn't happen again? So for us to have these open discussions about what their fears might be, then it's easy for us to say, "Okay. I know you're afraid and I understand why. This is why you may feel this way, but this is not true. And this is why this is not true." So we're able to really, I think, head off a lot of the fear before it becomes an out-of-control sort of thing.

Host: Right. That's an interesting tactic or strategy. And so are you just asking people to talk to you? Are you just showing up? You're just trying to be everywhere? How do you create a culture or maintain a culture of openness and transparency?

Ashley: I make rounds every morning. So I go to every department every day. If I can't do it every morning, I, at some point, make a round every day. I think that's part of the nursing in me is just to sort of be around.

Host: That's really neat how that's transferred over to that.

Ashley: Right. But I truly just love the staff. I mean, they have accepted me. I mean, it's nothing I'm doing. I assure you. They have been so accepting of me and have welcomed me with open arms. And they're truly like my family now. I mean, I know it's probably weird to hear me say that. I've not been here that long. But I mean, I know I could call any of them, and they would be right there for me. So it's just been a really great experience.

Host: Certainly, I'm hearing a momentum. And you're just continuing that momentum around the theme of empowerment with the employees. Anything else that comes in mind of just kind of what's contributed to that culture?

Ashley: I do know that they are very in tune to their own, especially the department directors, they're very in tune to their own departments. And when they feel like they need to speak up for their employees, they are very quick to come to me and petition on their behalf. And we really try to work hard to get what they need, whatever that might be. And we can't always do it. But we really try hard to at least show the steps that we're taking to get what they need.

And I think that has helped to sort of build trust and show that we are trying to reestablish some continuity, some stability, that culture of, "We are truly a family here. And you can trust what we're saying and what we're doing. That we really are all in this together, and it is going to work no matter what. We're going to make this work. That this rural hospital has to be here."

I mean, the closest critical access emergency department is 45 minutes from here. And we've had two children survive because we're still open. So we can't let this fail. I mean, it's not in our vocabulary. It's going to work. There's just no other option.

Host: I think that is the perfect place to wrap up this interview. I'm so thankful we got to talk with you about what, I also am a big believer that will be a textbook case study. And it's so nice that we get to kind of zoom right in right now to what you're seeing on the front lines with this incredible team. So any final things on your mind or on your heart? Feel good?

Ashley: Thank you.

Host: Thank you so much.

Ashley: Thank you for your time.

Host: I appreciate it. Thanks for listening to Health IT on the Record, presented by MEDHOST. For more stories and content like this, be sure to visit medhost.com/resources. Thanks.