FROM WHERE I'M SITTING...By jeff mero, executive director

More than the usual number of important meetings are coming up over the next few weeks. I will take a few minutes to identify some that I am especially excited about.

RHQN on the Examination Table will take place in both Spokane and Seattle. These meetings are a critical first step in evaluating the future of the Rural Healthcare Quality Network (RHQN). As nearly all of you reading this have heard, there are some serious questions to be answered about the RHQN's mission, vision and purpose. I hope each RHQN member has at least one informed person attend one of these sessions so the answers reflect the thinking of the largest possible number of members. The Spokane session will be Friday, June 9, 10 a.m. - 2 p.m., in Avista Rooms A and B in the new Women's Health Center at Sacred Heart Medical Center; the Seattle meeting will be Monday, June 12, 11 a.m. - 3 p.m., at the SeaTac Radisson Hotel--formerly the Wyndham Garden--by SeaTac Airport.

On Tuesday, June 6th, the WSU Center to Bridge the Digital Divide will facilitate an invitation only session at REI in Seattle to discuss progress toward creating a statewide tele-health "spine." AWPHD was awarded a FLEX grant last January for this project and the goal is to create a statewide information technology network that will support the tele-health needs of Washington's public and private health care providers. This meeting is designed to review work done to date and help frame the next steps, some of which I expect will lead to Olympia for legislative action. If you would like to see, comment on, or otherwise advise on this effort, please visit http://wa-thin.blogspot.com/ and tell us what you think.

On Tuesday, June 20th, AWPHD and the Washington State Hospital Association (WSHA) will be bringing a group of rural administrators together to discuss opportunities to improve service and support for rural hospitals and healthcare systems. This meeting grew from discussions at the WSHA Rural Hospital Committee and from the expanding list of projects and services we are being asked to address. The outcome of the meeting will be shared at the Administrator Only session in Chelan, which will be facilitated by WSHA President/CEO Leo Greenawalt and me.

In the meantime, all of the "normal" activities of daily living continue to find their way. We are planning a very good member meeting in Chelan this year, with State Auditor Brian Sonntag scheduled to discuss his new "Performance Audit" role and John Woodall from Washington Casualty Company (WCC) providing an update on WCC's gradual emergence from receivership. I expect both of these talks will be of more than a little interest.

We are also working closely with King County PHD No. 1 (Valley Medical Center, Renton) to help them respond to an investigation by the state Public Disclosure Commission (PDC). The PDC is looking into complaints related to the district's recent election to annex areas in southeast King County.

It is hard to believe it was only a month ago when AWPHD hosted its annual Administrators Only Retreat. This year's event, held at the Cave B Inn south of Quincy, was outstanding by nearly every measure. The evaluations found little fault with the educational aspects of the program, the physical setting was just spectacular, and Beionka Moore did a great job selecting entertainment and making sure we were all well cared for. I want to thank the fine people at Foster Pepper PLLC one more time for their financial and personal commitment to making this year's retreat "one of the best meetings I have ever attended" (a direct quote from an administrator whom, I can assure you, is neither easily impressed nor free with praise).

Looking forward to seeing many of you over the next few weeks…

SNAPSHOTS

Among the other AWPHD and AWPHD-related activities taking place in June are:

· Tuesday, June 20th--the noon web cast of Family and Medical Leave Act (FMLA) Considerations for Employers. Attorneys Karen Sutherland and Angela Belbeck from the Seattle firm of Ogden Murphy Wallace will be the presenters. For information on connecting to this web cast, e-mail Wendy Ray (wendyr@awphd.org).

· Monday, June 26th--the AWPHD Mid-Year Meeting at Chelan, which takes place at Campbell's Resort at 9 a.m. State Auditor Brian Sonntag is the invited keynote speaker and will be discussing Initiative 900, which requires his office to conduct performance audits of state and local governmental entities--including public hospital districts.

Immediately following the mid-year meeting, the RHQN will be holding a membership meeting in the Park Room of Campbell's Resort. And AWPHD's State Auditor's Office (SAO) Committee also will be meeting at Campbell's with SAO representatives to continue our collaborative efforts to improve the auditing of PHDs.

PHDs have until June 16th to submit letters of intent to apply for health information technology grants of up to $20,000 from the Washington Health Information Collaborative (WHIC). WHIC, a public-private partnership of First Choice Health, the Washington State Health Care Authority, Qualis Health, and the Puget Sound Health Alliance, has earmarked a total of $1 million for these grants.

Generally, the Collaborative will award these grants to Critical Access hospitals, as well as small and/or rural primary care physicians. Information on the grants is on-line at www.wahealthinfocollaborative.org

The possibility of an AWPHD web cast on two State Treasurer programs--the Local Capital Option Capital Asset (LOCAL) program and the Local Government Investment Pool--was raised in the January 2006 issue of In Focus. After assessing member interest and talking to two Deputy State Treasurers about the most effective and efficient ways to give you information about these programs, we've opted for other "delivery" methods.

In late September, AWPHD will set up a lunch time conference call between Doug Extine (the Deputy State Treasurer for Investments) and AWPHD members wanting to learn more about the Local Government Investment Pool. When the date and time are firmed up, we'll notify district CEOs, Administrators, and CFOs. Also, it's likely that materials will be sent out to participants in advance of the conference call.

Because districts have different revenues and debt loads, Allan Martin, the Deputy State Treasurer, Debt Section, thought that one-on-one discussions with his staff would be more useful than a web cast on the LOCAL program. So he submitted the following article to enable you to determine whether you'd like members of his staff to call or visit you.

"Smaller local governments, such as public hospital districts, are called on to carry out many of the same activities as larger organizations. However, because smaller local governments only infrequently perform some of these activities, they might not have the opportunity to develop the same level of expertise as larger organizations.

"One place this disparity might be found is in equipment and real estate financing. The LOCAL program allows local governments to realize efficiencies in financing that were previously available only to larger organizations.

"This program, launched in 1998, offers districts access to capital markets on a competitive-bid basis. Local governments benefit from the experience the Office of the State Treasurer (OST) has gained from issuing more than $1.2 billion of certificates of participation with over 2,400 separate financing contracts.

"The LOCAL program 'bundles' local districts' financings with those of state agencies, gaining economies of scale for all participants by issuing the debt collectively. In this way, the fixed costs of financing are spread over all the districts and agencies that participate in the issuance--the more participants, the lower the cost per transaction. This pooling of entities, combined with a competitive bid process, fosters favorable and competitive interest rates in the marketplace.

"All financing through the LOCAL program is based on a general obligation pledge. Participants are asked to complete a credit form to gain approval to participate in the program. The program uses standardized documents that have been scrutinized by a number of attorneys, so you can be assured there are no surprises 'hidden in the small print.'

"LOCAL is a great program for public hospital districts and all local governments, first because of the convenience of the financing and second, for the comfort of knowing you are working with knowledgeable finance professionals who are committed to customer service.

"Detailed information on the LOCAL program is available on the OST website at http://tre.wa.gov/LOCAL/local.htm or by telephoning the Office of the State Treasurer at (360 )902-9000."

Here are a few tips for district CEOs or administrators who want to use the AWPHD Listserv to obtain information from their colleagues:

1. You're likely to get more and faster responses if you--instead of AWPHD staff--put your inquiry out on the Listserv. Although we're glad to send out the request, we've found that people are more responsive when the request is a "peer-to-peer" request.
2. Specify an "information needed by no later than" date. Otherwise, responses will not be timely.
3. If the information you're seeking is likely to be of interest to many AWPHD members, an AWPHD staff member will ask you for copies of the responses you receive so we can compile them for dissemination to everyone on the Listserv.

PHDs considering construction projects--especially districts in rural areas--may want to learn from the recent experience of Greg Reed, the CEO at United General Hospital in Sedro-Woolley (Skagit County PHD No. 304). While the district was obtaining the necessary permits for its new medical office building, Greg received a letter from the state Department of Archeology and Historic Preservation (DAHP) that the project was within areas identified as an archeological site and a Native American archeological site. The DAPH requested that the district conduct a "professional archeological survey" prior to "ground disturbing actions" and also recommended that the district consult with the cultural committee of the potentially affected tribes.

The district did hire an archeologist, who through sampling on the site, found no evidence of cultural resources. Greg's suggestion: When your district is in the planning stages of construction that will involve ground-disturbing actions, contact the department to ascertain whether the proposed site is within an area of archeological importance. Had cultural artifacts been dug up during site preparation or subsequent construction activities, the DAHP's letter noted that "inadvertent discoveries often result in costly construction delays and damage to the resource."

In talking with DAHP staff, we found out:

· The DAHP is particularly concerned with activities taking place: (1) on land that has not been disturbed before; and (2) on land that is or was a shoreline.

· Skagit County PHD No. 304's involvement with the DAHP was triggered when it applied for permits from the City of Sedro-Woolley: this brought the State Environmental Policy Act (SEPA) process into play.

Had federal permits or funds been involved (including the provision of federal low-interest loans), the process would have been different. This other process--referred to as the Section 106 process--would have required formal government-to-government consultation with the affected tribes.

If ground-disturbing activities were to take place in identified archeological areas, only one process would have to be followed--one generally substitutes for the other.

· The DAHP handles both state and federal processes. If the construction does not involve federal permits or federal funding, contact Assistant State Archeologist Stephenie Kramer at stephenie.kramer@dahp.wa.gov or (360) 586-3083. When the project does have a federal presence (permits or funding), go to State Archeologist Rob Whitlam at rob.whitlam@dahp.wa.gov or (360) 586-3080.

· More information about these processes is available on-line at www.dahp.wa.gov.

If you're planning a construction project, you should be aware that "below ground" activities are just one area where there's potential interplay between your district and the DAHP. In the next issue of In Focus, we hope to make you aware of "above ground" (historic properties) issues which might result in DAHP involvement.

Governor Gregoire is looking for "strong citizen advocates" to serve as public members on several state commissions and boards involved in the delivery of health care services. The Medical Quality Assurance Commission, the Nursing Care Quality Assurance Commission, the Chiropractic Quality Assurance Commission, the Optometry Board, and the Board of Physical Therapists all have public member vacancies coming up in the next few months.

According to information provided by the Governor's Office, "these boards [and commissions] play a quasi-judicial role by regulating our state's health practitioners and holding them accountable to high standards of care."

Qualifications for each of these public member positions and information about what these commissions and boards do are found on the Internet at
http://www.governor.wa.gov/actions/appointments/boards/profiles/default.htm. (Although public members generally can't have a financial or fiduciary relationship with health care facilities, there may be people in your community who would be good public representatives.)

An application form is also available on-line at http://www.governor.wa.gov/actions/appointments/boards/application.doc.

PEOPLE AND PLACES

The Bellingham Chapter of the International Association of Administrative Professionals selected Arden Haines, executive assistant to Administrator Vince Oliver of Island Hospital in Anacortes (Skagit County PHD No. 2), as its Administrative Professional of the Year.

King County PHD No. 1 (Valley Medical Center, Renton) lost a May 16th election to annex areas in the southeast portion of King County into the district. Less than six percent of the voters in the proposed district supported the measure.

Network News

· Western Washington Health Care Collaborative

The Collaborative was just awarded a three-year network development grant totaling more than $500,000. The grantor is the federal Office of Rural Health Policy, Health Resources Service Administration.

· RHQN

The RHQN will be holding a Root Cause Analysis (RCA) Workshop on Friday, June 16th in Spokane. At this interactive workshop, Helen Harte, the patient safety director/risk manager for the Puget Sound Veterans Administration (VA) Health Care System, will discuss the VA and JCAHO models for conducting root cause analyses. Helen, who has RN, MPH and MPA degrees, has been working in clinical and operational quality improvement for 17 years.

During the workshop's group breakout sessions, participants will work on RCAs of actual adverse events and near misses. The workshop runs from 10 a.m. to 3:30 p.m. and takes place in Room 267 of the Deaconess Educational Center. For more information or to register for this event, please contact Brad Vollegraaf at bradv@awphd.org.

The RHQN also will be offering regional RCA workshops.

THE HEALTHIEST STATE INTHE NATION (HSIN) CAMPAIGN

[Editor's Note: Over the past few months, AWPHD Executive Director Jeff Mero has been urging members to become a "Participating Organization" in the Washington Health Foundation's HSIN campaign. Jeff has asked In Focus to highlight some of the HSIN activities of AWPHD members in upcoming issues and as reports come in, we'll publish them. The following item on Garfield County PHD's program in Pomeroy--Accounting For Health--was written by Harry Jasper, the district's CFO. For more information, contact Harry at Harry.Jasper@GarfieldCountyPHD.org.]

Results are in! Accounting For Health has engaged approximately 20 percent of its adult population in a community-wide health challenge! Each participant has completed a 10-minute initial health assessment that measures Body Mass Index, blood pressure, cholesterol, triglycerides, and glucose. Assessment report cards compare results to "ideal" ranges, helping participants to set improvement and/or sustaining goals. Some participants have cringed prior to viewing their results, others are really excited, but all have commented on how simple the assessment was and how informative and motivating the results are.

In April, Congresswoman Cathy McMorris and most of her locally based staff--six in all--completed their initial health assessments. At a meeting of her staff, she shared her enthusiasm and support for Accounting For Health, as well as the work of the Washington Health Foundation and Foundation Northwest, the two organizations providing grants for our challenge.

Accounting For Health's vision is to spread this unique challenge across the state--then nationally--with the aim of achieving improved and sustained community health. One key to this accomplishment is local, state, and national partnerships with organizations like the state Department of Health and Qualis Health, and policy leaders like U.S. Representative McMorris and state Representativse Bill Hinkle and David Buri.

Keep your health antennas up for more results in the months to come.

UPCOMING EVENTS

Statewide Tele-Health Spine Meeting
June 6 • REI, Seattle
Contact: Jeff Mero (206) 216-2519

RHQN Board Meeting
June 7 - 2:00 p.m. • Conference Call
Contact: Brad Vollegraaf (206) 216-2550

RHQN Membership Meeting
June 9 - 10:00 a.m. • Sacred Heart Medical Center, Spokane
Contact: Brad Vollegraaf (206) 216-2550

RHQN Membership Meeting
June 12 - 11:00 a.m. • Radisson Hotel, SeaTac
Contact: Brad Vollegraaf (206) 216-2550

WSHA Patient Safety Task Force
June 12 - 5:00 p.m. • Washington Athletic Club, Seattle
Contact: Angela Segerra (206) 216-2539

RHQN Root Cause Analysis Workshop
June 16 - 10:00 a.m. • Deaconess Medical Center, Spokane
Contact: Brad Vollegraaf (206) 216-2550

WSHA Executive & Finance Committees
June 16 - 7:30 a.m. • WSHA Offices, Seattle
Contact: Lisa Rusk (206) 577-1852

WSHA Medicaid Hospital Advisory Committee
June 19 -11:00 a.m. • WSHA Offices, Seattle
Contact: Melissa Waddell (206) 216-2510

AWPHD FMLA Web Cast
June 20 - 12:00 noon • Webcast
Contact: Wendy Ray (206) 216-2516

WSHA Safe Table Learning Collaborative
June 21 - 9:00 a.m. • DoubleTree Hotel, SeaTac
Contact: Angela Segerra (206) 216-2539

AWPHD Board Meeting
June 26 - 7:30 a.m. • Campbell's Resort, Chelan
Contact: Wendy Ray (206) 216-2516

AWPHD Membership Meeting
June 26 - 9:00 a.m. • Campbell's Resort, Chelan
Contact: Wendy Ray (206) 216-2516

AWPHD SAO Committee Meeting
June 26 - 11:30 p.m. • Campbell's Resort, Chelan
Contact: Wendy Ray (206) 216-2516

RHQN Membership Meeting
June 26 - 11:30 p.m. • Campbell's Resort, Chelan
Contact: Brad Vollegraaf (206 )216-2550

WSHA 30th Annual Rural Hospital Summer Workshop
June 26-28 •Campbell's Resort, Chelan
Contact: Danie Wright (206) 577-1845

WSHA Rural Hospital Committee
June 27 - 2:30 p.m. • Campbell's Resort, Chelan
Contact: Melissa Waddell (206) 216-2510

RHQN Board Meeting
July 19 - 10:00 a.m. • Conference Call
Contact: Brad Vollegraaf (206) 216-2550

WSHA Board Retreat
July 20-22 • Sun Mountain Resort, Winthrop
Contact: Lisa Rusk (206) 577-1852

The deadline for the next In Focus is Friday, June 23rd. Send articles or information to Dick Goldsmith (richardg@awphd.org, Fax: (206) 577-1897, 300 Elliott Avenue West, Suite 300, Seattle, WA 98119-4118.

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