Hospitals In Focus

Fighting COVID-19 in Rural America: A Hospital Leader Reports from the Frontlines


Despite being pushed to the brink during the COVID-19 pandemic, rural hospitals answered the call – fighting adversity to save millions of lives.

It was just another example of the important role these facilities play in the communities they serve. During this episode Chip talks to a veteran of rural hospitals – Doug Weaver, CEO of Hillcrest Hospital Pryor in Oklahoma, which is part of FAH member Ardent Health Services. He discusses the unique challenges his facility, and others like it, faced at the height of the COVID-19 surge.

Doug also talks about the changes in rural health care he has seen during his 40-year career – from the rise of telemedicine to growing staffing shortages. Additionally, Doug explains to Chip how being part of an integrated health care system, like Ardent, helps smaller hospitals keep their doors open to patients.

As the COVID-19 pandemic spread across the United States, every community was touched, but many rural areas were hit the hardest. Thankfully, the frontline caregivers at hospitals in these small communities did what they always do – they rose to the occasion, found solutions to problems and saved lives. But what really happened in the hallways of these rural hospitals when COVID-19 peaked – in this episode of Hospitals in Focus, we hear from a leader who was there.

Chip recently spoke with Doug Weaver, the CEO of Hillcrest Hospital Pryor in Oklahoma – which is owned by FAH member Ardent Health Services – to dig deeper into the impact that COVID-19 had on a rural hospital. Doug has been the CEO at several hospitals and has a career in health care spanning over four decades. His insight into the challenges that rural hospitals faced, not only during COVID-19 – but beyond, was second-to-none, as he went into extensive details on the challenges that Hillcrest Pryor faced.

Doug opened up the podcast explaining how the second wave of COVID-19 impacted their area the most “It really affected our community…about  27 or 28% of the people in our community actually had the COVID virus. The hospital was filled almost immediately. There wasn’t any place to stay.”

Hillcrest Pryor, like many rural hospitals, doesn’t have an ICU, but the staff was able to work quickly to adapt, “We have 21 private rooms plus our emergency department. Out of those 21 rooms we had to have our engineering department retrofit 16 of those rooms into negative pressure rooms for those (COVID) patients and that was done in the haste of the moment. They did a super job”

The Emergency Department became the makeshift COVID ward where they treated patients who needed to be put on a ventilator.

They used telehealth technology to get patients the specialized care they needed. Caregivers in Pryor were able to connect one-on-one with specialists at a larger facility in Tulsa to make sure proper treatment was being administered. “This was a lifesaving tool where we had real time physicians working with us.”

It was further proof to Doug that telehealth will be major contributor to care at rural hospitals in the future. “We can’t be all things to all patients. Telemedicine is that conduit to where we can tie in…Telemedicine will help keep patients at home. A lot of people can’t travel for care. Rural health care will depend on telemedicine to keep a physical presence in these communities, whether it is cardiology, pulmonology, or others”

Doug then turned his attention to his staff as well as staffing shortages. He acknowledged that the staff, while thankful for all the praise from outside the hospital, was experiencing hero fatigue. Doug said caregivers had approached him saying that they’re tired that they didn’t sign up for this. He added that the growing stress would lead to more staffing shortages, a problem that could go on past the pandemic, saying that we need more leadership across the country to end the nursing crisis.

“The #1 crisis in health care is the labor shortage. I think we need to sound the alarm to policymakers, business leaders, whoever – that this is going to affect all of health care. We have to figure out a way to keep health care workers in health care.”

Lastly, Chip and Doug discussed how systemization eased the burden felt by rural hospitals. Doug praised Ardent Health Services saying, “I think having a system approach, we were able to just take care of patients…From the medical professionals to the corporate office, we had regular calls to talk about everything from new treatment methods to needed supplies. It’s great to have that support. That’s the only way a lot of (rural) hospitals survived – the system approach.”

Be sure to celebrate Rural Hospital Week with us by catching the full episode here.

  1. HIV-Weaver-Final TranscriptPage1of6Speaker 1 (00:06):Welcome to Hospitals in Focus, from theFederation of American Hospitals. Here’s your host, Chip Kahn.Chip Kahn (00:16):Each November, FAH takes a week to recognize the importance of rural hospitals and the vital role theyplay in communities across the country. That role has been even more prominent during the COVID 19pandemic. Over the past many months,the pandemic has wreaked havoc on rural America. But in ruralcommunities, frontline caregivers at rural hospitals answered the call, saving countless lives.Today, we are joined by the CEO from one of those hospitals. Doug Weaver is the CEO ofHillcrestHospital Pryor, in Oklahoma. He has seen, firsthand, how rural hospitals have been impacted,especially in his area of Northeast Oklahoma. During this episode, we’re going to take a deep dive intowhat his hospital, and other similar facilities, have faced during these unprecedented times. Doug,thanks so much for joining us today.Doug Weaver (01:13):Well Chip, thanks for having me on. Look forward to the visit.Chip Kahn (01:17):To get started, Doug, I know you have had a long career in hospitals. You’ve mainly worked in areas ofOklahoma. Would you tell us a bit about yourself, your experience before Hillcrest, and maybe somehighlights of your career?Doug Weaver (01:30):Sure, be glad to. Like I said, been in healthcare a little over 40 years. Started in the clinical area, but gotinto management early in the career. Been fortunate to lead some great hospitals. Most of myexperience is in rural healthcare in Oklahoma. I was at a large hospital in Southwest Oklahoma, and itwas a trust authority county hospital. And we were the regional referral that the rural hospital sent in.So, got to experience that side of the healthcare. Also, ran two other rural hospitals, in another part ofthe state, and then came here about 11 years ago and started working for the present hospital that I’min. And you ask about some accomplishments. To keep it brief, I think one of the accomplishments, Iguess, I’m most proud of is to able to help a couple of hospitals do complete turnarounds. That’s notonly on the financial, but to get them where the community got involved. We definitely developedcultures to where the people that worked for us in the hospitals put the patient first.It was patient safety, patient quality, and we had great success with that. So those communitiescontinue to have healthcare and, it’s good to leave a place and say that maybe we affected somebody’slife in a positive manner. So again, the hospital I’m at, here, has been a great hospital to work for, a littledifferent with the type of management that we have and who we’re associated with now. All of themare a little different, but I’ve been blessed to have some great places to work.Chip Kahn (03:03):Well, I guess over the last 18 months, you’ve seen so much with the pandemic probably unprecedentedin your long career, too, as well as all of us in healthcare. So when it comes to the recent surges over thislast year, and particularly this summer, how was your hospital and your community and your patientsimpacted?

  2. HIV-Weaver-Final TranscriptPage2of6Doug Weaver (03:25):We were definitely impacted. You make a good point. Been doing this a few years, and I don’t think anyof us have seen what’s happened in the last 18 to 19 months. No different in this community. The firstsurge that happened last year was a little different for us. About 45 miles outside of Tulsa, Oklahoma,which is, of course, a definitely a larger referral center… One of our major Metro hospitals that we referto is located there. They were seeing mostly the brunt end of the sickness. We did see some comethrough here. We did have COVID patients come in. It was strange forus. A lot of our nursing,respiratory therapists, the different clinical people, have not worked in those type of areas. It wasstrange to them to try to treat them with all the PPE and the stuff going on. The Emergency Room wasdefinitely affected with those type of people, walking in the door and not knowing whether they hadCOVID or not.The one that really hit us was the second surge. It really affected our community for ourcommunity about 27, 28% of the people in our community actually had the COVIDvirus, which was veryhigh. We’re a county of about 40 to 42,000 people. Out of the county, we had 17%, I think was thenumber, that was affected. So definitely the patients were affected, our hospital was affected. Thesecond surge was where we got hit real hard. That was a time where Oklahoma, Northeast Oklahomastarted. And there wasn’t any place to send these patients. So what happened to a rural community likeus is we became a quasi tertiary center where we were keeping all types of patients, the very, very sick,and it was an experience for us. Our staff actually had to do things that they weren’t used to doing. Andrightly so, did a super, super job. Of course, you know, as we see in the news and it affected uspersonally, there’s some tragedies with families, loved ones. Actually, we lost some employees that hadCOVID. So, you know, it affected us in a big manner, here at this hospital,Chip Kahn (05:32):You know, as with many rural hospitals, Doug, and as you pointed out, you’re not a tertiary center, soyou don’t have an ICU. What job assessments oradaptations did you and the staff need to make, to dealwith these COVID patients who had such high acuity, when you couldn’t transfer them to some otherhospital?Doug Weaver (05:52):Yeah, that’s true. We don’t have an ICU here. We have… 21 private rooms is what we converted ourhospital into, plus our Emergency Department. Out of those 21 rooms, we had to retrofit and haveEngineering Department make 16 negative pressure rooms, where we could put those people in it. Andthat was done in the haste of the moment. I mean, they did a super job at doing that. The EmergencyDepartment became our, what we’d call, quasi ICU. That’s where, if a patient had to be put on aventilator, instead of putting them on the patient floor, that was where the most critical people went.And we actually did run an emergency room, have those people in those rooms on ventilators, we didhave 24/7 doctor care, which was why we put them there. And, you know, the ED Nurses are reallymore used to the trauma, those type of critical situations of running cardiac drips or the different typesof medicine that had to be put in.So, that became our ICU. And we were holding people for many, many hours because, again,there was no room in the inn anywhere. We were trying to go as far as five to six states out, fromOklahoma, trying to get patients. That’s all the way to North Dakota, Colorado, New Mexico, Iowa. Andpeople were actually calling our system office, which is in Tulsa, trying to transfer people to Oklahoma.So it was a critical time. Again, that’s the retrofits we had to do. So we practicedICU medicine in our

  3. HIV-Weaver-Final TranscriptPage3of6emergency room, and then the less sicker COVID patients, that didn’t need ventilators, were on ourpatient floor.Chip Kahn (07:30):Doug, what role did Telemedicine play during this period in the way your hospital operates?Doug Weaver (07:37):Telemedicine, to us, is probably becoming one of our staple services. We, at that time, were doingTelemedicine withour Hospitalist Program, reaching out to physicians in Tulsa, after hours, where youbring an iPad into a patient room and they can talk to the doctor and the nurse can utilize that type ofmodality. When the COVID hit, we started using that in our Emergency Department and we hooked intodoctors in Tulsa, at our main hospital, that were Intensivists Pulmonologists, Infectious Disease, all ofthose types that probably you don’t see in rural healthcare. So they were communicating directly one onone with ourphysician in the emergency room, and with our nurses. And that’s how care was given.They would help with the ventilator patient or an infectious disease patient of what type of antibioticswe had to put in for that COVID patient. Definitely, we had the personnel that could handle that, but itwas a communication tool that was, I’m going to say, a life-saving thing for us, where we had real timephysicians working with us.Chip Kahn (08:39):I assume you see that extending into the future. Are there other ways Telemedicine, you think, couldcome to impact care in rural areas?Doug Weaver (08:48):I think it’s going to be astaple. I think Telemedicine is the future of rural healthcare. You know, we can’tbe all things to all people and Telemedicine is that conduit to where we can tie in. We will be… Youknow, in today’s time you have to be very sick to be in the hospital.And, if the major metro centers fillup, then Telemedicine will help us keep patients here at home. A lot of people don’t have the privilegeto travel and to go to different places. I think you’ll see rural healthcare depend on Telemedicine to keepphysicians and a physician presence, whether it’s cardiology or pulmonology, some of those wherethey’re not coming out all the time, or we don’t have 24/7 care. This is how I think this care is going tobe given in the future. So Hospitalist programs, we can’t keep Hospitalist every hour in the hospital. Soit’s became a staple for us. That’s how we practice medicine, now is through Telemedicine.Chip Kahn (09:42):You know, during the first months of, of COVID, there was a lot of discussion about the heroes in thefrontline, in hospitals, in EMS. I’ve had a chance, though, to talk to several frontline workers, during theCOVID crisis, well, recently. And one thing I’ve heard about lately is, what I’ll call, hero fatigue. What areyou seeing among your staff and how, as a leader, do you keep people motivated when the pressureofCOVID seems to just keep extending over time?Doug Weaver (10:13):Chip, that’s a great point. We are, are experiencing just what you talked about, hero fatigue. And I wantto say every person in the hospital is a hero, from the admission person, all the way to that RN thatworks at night or that Respiratory Therapist that’s taking care of a COVID patient. They’re tired. Theyreally are. And what you just stated is it’s not letting up in a sense. There’s a little lull, right now, which

  4. HIV-Weaver-Final TranscriptPage4of6we’re very gracious and thankful for. But they’re tired, and they’re coming to usto the point to say,”Hey, I didn’t sign up for this.” You know, in rural America, again, with hospitals that don’t have intensivecare and we don’t do the type of medicine where a lot of people, I’m going to say, graciously pass away,our people have seen a lot of that and that’s affected them.We’ve actually had doctors that were in our hospital, was to the point with fatigue and, they’reheroes in their own sense. But they were telling me that they didn’t sign up for this either. Maybe it’stime for them to get out. So when you see RNs that’s practiced 30 years, and are great, great RNs, sayingthat they’re tired, they just need a break, they need to get away from this, it’s not what they want to doanymore, it’s became the number one problem in healthcare is our labor shortage and labor. So we areexperiencing that here.You talk about leadership. Again, talking to a lot of peers across the country, we’re leadingdifferent. And I’m not sure you can put any particular thing on that. But, you know, you support them,you can do all the things, whether you give them free meals and all the gimme’s that you want to givethem. But sometimes they just want somebody to come up and say, thanks and put an arm aroundthem and, you know, tell them that we support them. And and I think that’s how we’re leading, is tobecome part of that support system. We’re there for them. It’s not always about money, but is a big partto keep them. But sometimes it’s just that, thank you, that they need. And somebody to say, “Hey, I’mhere with you.”Chip Kahn (12:10):You know, from thispandemic, we’ve had these staffing issues that you’re talking about. Do you think,looking into the future, that the staffing questions are going to be, sort of, endemic and you’re going tobe dealing with them once we get beyond COVID, in terms of makingsure you’ve got sufficient numbersof nurses and techs and others to serve the patients in your hospital?Doug Weaver (12:32):Yeah. You used a good word. It is endemic. We notice that now. We think it’s going to get worse. I thinkus out in the trenches or in the field are seeing that. We know it’s not over yet. Thisyear has been very,very tough, but we know it’ll go into next year. Again, number one crisis in healthcare is labor. And Ithink if we had to sound the horn to whoever it may be, to the policy makers, to the business leaders ofthe world, whatever, it’sgoing to be there. And that’s going to affect healthcare. Healthcare’s got tochange. We’ve got to figure out how to keep workers in healthcare because healthcare’s not goingaway. I mean, all of us are going to have a health issue at some time in our life. And we definitely wantthat RN there. And it’s not only… Like you said, it’s all the clinicians. It’s everyone in the hospitalhealthcare industry that’s feeling this. So, again, probably the number one thing right now that we’redealing with in healthcare.Chip Kahn (13:25):Hillcrest Pryor is part of Ardent Health Services, one of the Federation’s members, I might add. Can youtalk a bit about what it’s like to be part of a larger healthcare system as a rural hospital and how that hashelped you and, particularly during this pandemic, what role the system playedversus just being anindependent hospital?Doug Weaver (13:46):I think the system is what saved us. I think, having a system approach, we were able to take care of thepatients we took care of because of who we were with. That comes all the way from the supplies that

  5. HIV-Weaver-Final TranscriptPage5of6we needed. When a system can purchase supplies internationally and have it drop shipped to a locationand then drop shipped to our hospital, as an independent hospital standalone, I wouldn’t have beenable to do that. So, from the materiality of things, of having them touch those items, that definitelyhelped us.On the personal side, when you have medical professionals at the corporate office or a divisionaloffice, we would have calls two times a week and talk about everything from what’s going on at eachhospital, the new treatment methods, what supplies we needed as of yesterday, today, tomorrow. Thatwas a big plus. So, when you have a large system such as ours, we’re not large, but I mean, quite a fewhospitals in our system, it’s great to have that support. And, whether it’s a financial support or,like yousaid, the people support, that’s about the only way a lot of places could have survived, is with thesystem approach.Chip Kahn (14:59):Has your hospital been impacted by the pandemic relief programs created by Congress, like the ProviderRelief Fund? And, if it has, what role has it played in terms of yourcontinuing to assure access forpatients in the surrounding areas?Doug Weaver (15:16):Sure. We took advantage of that. And I think Arden, as a company, took advantage of. That’s anotherpositive thing as being part of a system such as Arden. Arden has the expertise to be able to maneuverthrough those complex ways to be able to optimize the use of those federal programs. It did help uswith, whether it’s labor cost, supply cost, buying capital equipment. We definitely took advantage ofthat. I think we need that going forward. Rural healthcare is not out of the woods. So Arden is a bigplayer in that, of course, through the support they have on a national level. That’s what helps us.Chip Kahn (15:55):Sort of, keeping on that tack, if you had a chance to talk to lawmakers up here in, in DC directly, whatwould you tell them about the community impact of smaller rural hospitals, like yours, and what youneed in terms of help to keep serving the community?Doug Weaver (16:13):You know, a lot of people in the beltway or in Washington… Of course, quite a few of them are fromrural areas. But I guess my talk to them, which I’ve been to Washington and I go to Oklahoma city and Iplay that game also, is I make sure that they understand how much of an economic impact we are.Sometimes, we’re the largest employer in these communities. We have a great workforce. It providesstability to the community where people have the chance to get local healthcare. They don’t have totravel. But we cannot let that go. I think, as an economic driver, it helps bring industry into our area.A lot of people look at schools and healthcares, you know, if they’re going to be moving to acommunity. And, if I was talkingto the policy makers, I’d say, “Hey, the rural healthcare is needed. Ruraleconomic development is needed, and we need to have those funds continuing to come to ruralAmerica.” Standalone hospitals are almost a thing in the past. That’s just… We can’t… You, you won’tsee those very much anymore. So we are going to need support through systems. We’re going to needsupport through policy to be able to stay alive and to keep these hospitals open.Chip Kahn (17:23):

  6. HIV-Weaver-Final TranscriptPage6of6Doug, this has just been terrific. And I want to express our appreciation for your service. Just sogood tospend time with you this afternoon.Doug Weaver (17:32):Well, thanks for having us and I appreciate sharing our story.Speaker 1 (17:40):Thanks for listening to Hospitals and Focus, from the Federation of American Hospitals. Learn more atfah.org. Follow the Federation on social media at FAH Hospitals and follow Chip at Chip Kahn. Pleaserate, review, and subscribe toHospitals in Focus. Join us next time for more in-depth conversations withhealthcare leaders.