Rural Oregon hospital leaders discuss the unique challenges their organizations face


Shane Ersland


Rural hospital leaders discussed the challenges their facilities face, including staffing and retention issues, and efforts to address them at the 2022 Oregon State of Reform Health Policy Conference.


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Robert Duehmig, Interim Director at the Oregon Office of Rural Health, said the organization defines “rural” as a geographic area 10 or more miles from the centroid of a population center of 40,000. 

“And remember we have 10 frontier counties in Oregon, which is 6 or fewer people per square mile,” Duehmig said.

Duehmig moderated a discussion with rural health care leaders to identify specific concerns. Eric Swanson, President of Adventist Health Tillamook, said the organization is spending about $400,000 a month on contract labor, which erases any profit margin it could otherwise have this year. 

“That’s our biggest issue,” Swanson said. “We also have an issue in our clinics. We don’t have enough medical assistance. Trying to staff the clinics with some of those specialty licensures is difficult, and I’ve got a shortage of EMTs and paramedics.”

Adventist Health is working closely with Tillamook Bay Community College (TBCC) to help address workforce needs, Swanson said. 

“Next year, TBCC starts their own nursing program,” Swanson said. “We’ll be starting a paramedic program next year. They have a [Medical Assisting] phlebotomy program and we’re in discussion about a limited license X-ray tech program. We look at all the fields we don’t have and we go to TBCC. They’re an amazing partner. They’re our most important partner when it comes to recruiting. We hire more people from TBCC than any other single source.”

Brian Moore, President and CEO of Bay Area Hospital in Coos Bay, said the retention of staff is also a cause for concern and an effort that has grown more challenging due to workers becoming burnt out due to the COVID-19 pandemic.

“Physiologically and psychologically, they’re responding perfectly normally from a burnt out environment,” Moore said. “The organizational driver of that is a mismatch between the demand of the job and the resources to meet that demand. The resources aren’t there. We can’t change the number of patients that we have to care for. Can we make it feel different?”

Bay Area has rolled out some evidence-based rounding tools to try and improve workplace morale, Moore said.

“[We’re trying] to make sure that, after two years of [workers] being masked and remote, we’re starting to regain that personal connection,” Moore said. “Nurses want to know their voices count. We lost a little bit of that.”

Orion Falvey, Co-founder and Executive Director of Orchid Health in Oakridge, said workloads have also become more difficult to manage due to the pandemic.

“Workloads are tough to control now, especially with the staffing shortages,” Falvey said. “But trust and autonomy, and efforts to think structurally about how we organize healthcare organizations to give more autonomy to the people on the front lines [is] absolutely crucial now. Otherwise we’re going to be on this wheel of turnover, and if we’re losing half our workforce and having trouble building the pipeline, we’re not getting ahead on the problem.”

Swanson said Adventist Health recently hired a Well-being Director to improve caregiver career longevity.

“We hired a Well-being Director who’s going to be solely focused on the well-being of our associates,” Swanson said. “Our well-being work is going to go outside the hospital walls to help them with things at home as well.”