Kirby: A model for fixing rural health care?

Michael Williams began his career 32 years ago as a respiratory therapist at Fairfield Memorial Hospital. After advancing to head of the hospital’s respiratory services in just two years, he propelled through other leadership positions, from radiology to rehab, before landing in the CEO’s seat eight years ago.

When he retired this fall, he had a much clearer picture of the way forward for rural health car.

“I love Fairfield County, he said, “but rural health care has got to change.”

And change came under Williams’ leadership.

When he ascended to CEO in 2008, Williams became the first African-American hospital CEO in South Carolina. As with many industries, minority representation is still a work in progress for hospital C-suites and boardrooms. The Institute for Diversity in Health Management reports that in 2012 just 14 percent of hospital C-suite positions were occupied by minorities, and more recent data from the American Hospital Association’s National Healthcare Governance Study show that 47 percent of nonprofit hospital governing boards had no racial or ethnic minorities in 2013. But Williams never considered that a stumbling block.

“You only think about it a second and it goes away,” he says. “You see other blacks in the room, but they’re not CEO. And you see the same thing at national meetings. I don’t dwell on it because I know we’ve got to move on.”

As CEO, Williams moved quickly to refocus the way the hospital operated, in order to maximize efficiency. He used technology to move to virtual radiology and expand telemedicine services to include tele-psych and tele-stroke. He developed an innovative “hospitalist hybrid” program in which the emergency room physician also serves as the hospitalist, providing care and managing the patient experience at the same time.

Williams believes federally qualified health centers and rural health centers are a key ingredient to improving health in rural areas. He improved access to care in western Fairfield County by helping the hospital establish a health center in Jenkinsville to serve the area’s low-income, underserved population. And while he believes that access is key for population health, he understands that rural hospitals must change the way they operate to be sustainable.

For Williams, that meant making tough decisions, such as eliminating breakfast services and no longer serving employees in the cafeteria. While hospitals in more affluent areas look to expand amenities, Williams recognized that hospital employees simply weren’t eating in the cafeteria, and the wasted food costs were significant. He also revamped the hospital’s leave policy to save the hospital $1 million.

It’s all in keeping with his advice to rural hospitals looking to keep their doors open in a time when reimbursement is becoming leaner and health care is becoming more consumer-driven: “The revenue days are over. It’s about managing expenses.”

Williams knows that more appealing health care markets such as Columbia are just a short drive away, and that rural hospitals should no longer try to compete with those markets. Instead, they must focus on the services most needed in their communities.

“Evaluate your system,” he says. “And don’t let people tell you what you can’t do. Just go in and work.”

This story was originally published November 29, 2015 at 4:00 PM.