At just over 12,000 souls, Mountain Home, Arkansas, shares a lot of the same characteristics of hamlets across the Natural State and elsewhere.
Except in self-image. While many small towns struggle with population loss, job stagnation and lack of opportunity, this community has kept population steady, rebuilt its downtown district and packs in retirees and tourists alike on the strength of area scenery, pace of life and fishing.
And one of the big drivers of the town’s health, literally — to say nothing of its regional reputation — is its homegrown hospital, attendant clinics and other elements of a first-class health care system. Truly, if there’s one thing to encapsulate the town’s can-do attitude, it’s Baxter Regional Health System.
“When I came to Baxter, I was very specific in what I was looking for,” said Ron Peterson, president and CEO, who arrived in Mountain Home 14 years ago. “I wanted a hospital that provided urban medicine in a rural setting because I believe it can be done, and people in a rural environment deserve that.
“When I came here, I saw that Baxter Regional also had a heart; it cared about people. In addition to providing good clinical care, the staff here still cared about the individual and had good ways of showing that. That made me want to be a part of what we have here.”
On almost every measurement, Baxter Regional has achieved things that would be the envy of even much larger organizations. In Peterson’s tenure alone, the system has completed multiple construction and expansion projects, as well as building out a network of clinics in smaller surrounding communities. Just in the last 18 months, the system has christened a new surgical center and entered into a partnership with an oncology group that’s building a new 30,000-square-foot cancer center here.
These facilities line up next to a women’s health center, a center specializing in diabetes, an adult behavioral health unit and a Level III Trauma Center, to name just a few amenities, in addition to the 268-bed (all private) hospital.
Baxter Regional, employing roughly 1,800 people, leverages these amenities to serve an 11-county market area. Among them are an impressive array of 180 primary care and specialist physicians covering a multitude of medical niches. An additional 500 volunteers provide daily services from parking lot shuttles to staffing the gift shop to manning the information desk.
But even more striking than square footage, the high-tech diagnostic and treatment equipment around every corner and fancy medical titles is the recognition the health system has received from the governing arbiters of hospital quality. Baxter Regional has been repeatedly recognized for patient satisfaction and level of care across multiple areas of operation.
Merely scratch the surface among these and you’ll find a Top 20 Rural and Community Hospitals in America ranking in 2018. And Baxter Regional achieved the ultimate endorsement of its nursing program, Magnet Recognition, in 2021. That designation, held by fewer than 550 hospitals in the world, is one of only five currently awarded throughout Arkansas and southern Missouri. Not bad for a health system that in 1963 opened as Baxter General Hospital with just four physicians and 39 beds.
Lane Zimmerman, chairman of the board of directors, said such accomplishments infuse a sense of purpose and pride at every level of the organization.
“I think the main thing is the tradition and history of striving for excellence, really trying to make sure customer care comes first,” he said. “It comes from the top down. When Ron [Peterson] speaks publicly, you can see how much he cares about the hospital. The employees really buy into that, and they become members rather than employees. They’re part of the hospital and see themselves as a team.
“I think there’s a huge amount of word-of-mouth recommendation that goes around to surrounding counties that there’s good people here; there’s great, clean, modern facilities here with the most modern equipment. You can come here and get the care you’d get in St. Louis, Houston or Little Rock. I think people trust the tradition here and are happy to have something that’s close to home.”
Seeing such world-class innovation and expertise happening in a community this size flies in the face of industry trends. According to the 2019 Rural Report published by the American Hospital Association, rural and small-town hospitals have been under attack by market forces and increasing regulation for decades. Despite roughly one in five Americans living in a rural area, thus depending on local hospitals as their primary, or only, health care access point, many such institutions have struggled to keep from flatlining.
Between 2010 and 2018, nearly 100 rural hospitals closed nationally, per the AHA. Meanwhile, between 2005 and 2016, there were close to 400 mergers involving rural hospitals with some locations merging more than once in that time span. The report cited a number of factors for the decline, including lower patient volume and a payer and patient mix that trend toward sicker, poorer individuals whose care needs far outweigh federal reimbursement tables.
COVID-19 has done these organizations no favors, according to a study from the Chartis Center for Rural Health, the results of which were released in February. It found almost half of 2,100 rural hospitals polled were operating in the red due to loss of outpatient procedures canceled by the pandemic. The situation cost rural hospitals a reported $5 million to $15 million in revenue per month, and, the study found, has driven 450 such entities to the brink of closing their doors.
Asked point-blank how many times Baxter Regional entertained a serious merger offer on his watch, Peterson answered fast and firm.
“Never,” he said, emphatically. “Our board has always said our goal is to remain independent, and in the 14 years I’ve been here, in all honesty, we’ve really never been close [to merging].
“Now, we did realize the realities of remaining financially viable, and what we figured out was we needed to grow and continue to focus on growth. Whether that was a new service for the community, expanding our footprint or deepening our footprint in the communities we were already in, we’ve remained focused on growth and financial stability.”
Asked how Baxter Regional has been able to resist the market riptides that have pulled so many peer hospitals under, Peterson said it starts with an unwavering mindset that permeates the entire organization.
“What really turned the corner for Baxter is, we identified our purpose, and that was to be independent, comprehensive and community-driven,” he said. “When we started believing that’s what we needed to do, that no limitation could be put on us, that’s when we started thinking big and strategically.”
Nowhere does this power of positive thinking shine brighter, both in-house and in the community at large, than through the Baxter Regional Hospital Foundation. Barney Larry, a former community banker who joined the foundation as its executive director, has seen this phenomenon up close for 21 years.
“I really believe the hospital sets the culture for our community, and for us, it’s the people we surround ourselves with that set that example every day,” Larry said. “We have over 500 volunteers who serve here, and they take ownership of this hospital. They’ll tell you, it’s their hospital. They’re our advocates in the community; they see our needs, and as many of our volunteers who are very philanthropic, they help us lead that charge.”
During Larry’s tenure alone, the foundation has conducted eight capital campaigns, one of which sought to raise $2 million in 12 months, which it did with time to spare. This community support is something Larry never takes for granted, even as it rises up to meet one financial ask after another.
“We just have a great community,” he said. “We care about each other. I think it’s a community that really wants all of us to find better ways that we can serve each other, and we do that through the hospital many times over.”
As Baxter Regional added to its run of success, goals became bigger. Today, winning is considered a way of life. Chief Nursing Officer Shannon Nachtigal has seen the process in action repeatedly, resulting in national rankings and the crowning Magnet status, as well as being carried out in a thousand ordinary ways every day.
“We started really focusing on what motivates and drives behavior, and it really, basically, starts with leadership,” she said. “As we’d reach certain milestones, we started making those part of performance reviews, so that we could then drive that accountability. Once you’ve been educated, once you’ve been trained, once you say you understand it, once you agree it’s an expectation, then accountability comes naturally.”
Over time, Nachtigal and her fellow leaders also stoked a healthy competitive streak in their respective areas of operation, enough for employees to strive, but not so much that they couldn’t celebrate each other’s wins.
“I definitely believe that when the organization wins, all the employees feel the win,” she said. “So, if we’re the number one home health in the nation, all of our employees are proud about that, even though they may not work in home health.
“But on a smaller scale, whatever department you work in, you always want to be the best department. You want to be the one department that really is the one that helps the hospital get to its goal. So, while there is some departmental competition, in the end, everybody is excited and happy when the organization succeeds.”
Arguably the most impressive element of Baxter Regional’s success is, even with all it has achieved, hospital leadership continues to find things to shoot for and top itself. For Larry and the foundation, it’s the latest capital needs, such as the $1.7 million required to remodel the surgical area (and of which they’ve raised $1.2 million in about six months.)
For Nachtigal, it’s the challenge of attracting not only enough nurses, but the right nurses whose care for their patients and team members equals their medical expertise and then integrating them into the team culture. Those who do thrive long-term; those who don’t are quickly weeded out.
And for Peterson and board members like Zimmerman, it’s maintaining an audacious strategic vision, anticipating new ways to build value into the health system’s services, be it cutting-edge surgical robots or rolling out digital tools that help people tap into telemedicine.
Whatever that next big challenge may be, one thing is for certain: Baxter Regional leadership at every level has ample motivational ammo to inspire future success, both from the strides that have already been made and in the people who have taken those steps. And they aren’t afraid to use it.
“I always think of the little train who could; we are the little hospital who could,” Peterson said. “There are several things you can do on a national basis to get good ideas and help from other places. Once we started having small wins, pretty soon we found ourselves presenting as much as we were listening. That’s led to a mindset that, wow, we are blessed with really talented people here. If you let them lead a project or deliver the solution, you generally see great results.”
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