Doug Ekeren has jumped into his new duties in Mitchell.
Ekeren took over as the interim regional president and CEO of Avera Queen of Peace Hospital in Mitchell, taking over for Tom Clark in July. That’s paired with his existing job holding the same position at Avera Sacred Heart in Yankton.
He has been Avera Sacred Heart Hospital Regional President and CEO since 2014, and worked in hospital administration in Yankton for more than two decades.
Ekeren moves into the interim Mitchell role during a critical period in health care, dealing with the COVID-19 pandemic, and trying to limit its impact on hospital, clinic and nursing home employees, along with long-term care residents.
But South Dakota is currently being challenged by the virus, which has 124 active cases in Davison County, through Tuesday. As of Sept. 23, Avera Queen of Peace had nine patients in the hospital with COVID-19, Ekeren said.
Ekeren took some time recently to answer questions from the Mitchell Republic about his new Mitchell role, what has stood out to him and the local response to COVID-19.
Q: What are your impressions since moving into this role where you're overseeing Avera Queen of Peace and the hospitals that are in Mitchell's region?
A: I've been very impressed with the hospital staff and the medical staff that I've had a chance to interact with over that time period. And when I say hospital staff, I mean, inclusive of our Grassland campus, and also Avera Brady (Health and Rehab), and our other service locations that we have in the community, I would say I think we've got an excellent leadership team here. Our board of directors, representing the community and our sponsors, and the medical staff we have are very engaged. And so I've been spending my time talking with community leaders and board members, physicians, certainly the leadership team, I probably have more contact with than anyone. But I've also taken time over the last couple of months to listen to our employees at Avera Queen of Peace. I've had about 10 small group discussions with them. And I think it's evident that everyone takes up a lot of pride in the services that are provided here in Mitchell, and the ability to provide high-quality services, as evidenced in our quality metrics that we monitor from the publicly reported information that comes from (Centers for Medicare and Medicaid Services) and the Five-Star Ratings. And that should be reassurance to the community that we're doing the right things at the right time. And yet, there's also opportunities for us to look at other services.
Q: When it was announced that you were taking this job, you said you wanted to listen and wanted to spend some time getting “boots on the ground” and really take in what is all on the table. So now that you’ve had some time to do that, what are you hearing and what are some of the things that are your focus?
A: Because obviously things change in the environment, and people access services, you get more feedback all the time. And we need that from the people that are using our services. And quite frankly, we need to hear from the people that aren't using our services and need to figure out why that is and what we can do to keep them accessing health care and doing that here in Mitchell. … We continue to focus on health care costs. What can we do to be more efficient because they'll keep our charge to the patient and charge to the payers at a lower level? And how do we provide more for those dollars that we're charging? How do we ensure that we're doing that locally here in Mitchell? That's where I think one of the major strengths that we have in the health care system like Avera, we don't have to reinvent the wheel. We are the benefactors of being part of Avera and the expertise and the decision-making that comes with that.
Q: It’s hard to have any conversation about health care now without COVID-19 being a major discussion. Where is Avera Queen of Peace right now as far as how well you feel COVID-19 is being handled?
A: Yeah, I think we feel very good about that. Again, the strength of the health system, and using that strength to help us prepare and deliver services locally has been critical with this, especially with as much information as there is coming from CDC and other sources on at least a weekly basis, if not daily. And so how do we plan for that? How do we help our local schools, our post-secondary education and businesses in our community to deal with this, as well as obviously ourselves as health care providers. That will be a work in progress until either we have vaccines or something else happens that we can move forward in a different direction. But for right now, protecting our staff so that they can care for our patients is critical. And obviously ensuring that anybody coming to our campuses is protected. So we feel very confident that from my cleanliness perspective, from a social distancing, and mask requirements that we have in place, that our facilities are safe for patients to come and access health care services at as new things are learned about the virus, and we need to tweak some of those processes when we do that. Certainly what we do today is different than what we did in the middle of March. We'll continue to evolve, as we learn more about the virus.
Q: By all indications, we still have the hospital capacity in South Dakota to handle more hospitalizations. But is that daunting to you right now, given where we're at, and that South Dakota has a lot of serious cases at hospitals around the state?
A: Yeah, we're really at a peak right now. We're at the highest hospitalizations that we have seen for COVID, at least within Avera. And we have the highest number that we have seen for Avera Queen of Peace. That being said, I don't think that the real issue for us is going to be hospital capacity from a bed or from a ventilator perspective, like were the concerns early on. It's going to be more from a workforce perspective, if we have workers who cannot work because they have been exposed or family members have been exposed. And so they need to be isolated. That is going to be our biggest limiting factor in terms of taking care of people, whether it's in the hospital or in our long-term care facilities. And that is, that might be our biggest challenge right now is just ensuring that we've got the workforce. We're fortunate that we have a low hospitalization rate and a low death rate. It's still serious and we need to take it seriously. And I think that when we look back to the early days of the pandemic, there were projections that we might see over 100 COVID patients at a time here at Avera Queen of Peace. You know, we had to take that seriously, we had to prepare like that could happen. Fortunately, it didn't. We've been able to manage this at a much lower level of hospitalizations. And that's been critical because that type of patient volume would have simply overwhelmed us and overwhelmed our staffing at a point where we may not have been able to send those patients anywhere else if the rest of the state was surging at the same time. And we have seen that scenario play out in other states. But fortunately not here. So I think for us, we continue to talk about how do we keep our staff safe and protected when they're at work. We're hoping that they're taking those same practices into their away from work, to keep them safe so that they can remain on the front lines and helping us take care of the patients who do come to us who need assistance working through this COVID pandemic.
Q: There’s been a lot of discussion on long-term care facilities with COVID-19. What is your view on handling those residents and allowing as much interaction as possible with their loved ones and how is that evolving?
A: Yeah, it's a challenging thing, too. I think every nursing home in our system would love to have more family visitation allow that physical contact between families and residents. Unfortunately, until we have a way to ensure that those family members aren't COVID positive, we’re going to be limited in some regard. And the long-term care population is so susceptible, we're working hard to try and keep the virus out of our facilities. At the same time, we know that that lack of contact between residents and families is not good for our residents either. So we're working through some options. We've done virtual visits, and while the weather is nice, we can do outdoor visits. But we know those don't replace the type of more intimate contact that people want to have and to be able to, to put their arms around their mother or grandmother or whoever in our facilities. And so we do have some creative options that we're sharing, where it still keeps a physical barrier between but can actually do some hugging.
In terms of encouraging visitation, the South Dakota Department of Health has been very helpful in wanting to allow for family visitations. However, they're all within the context of what type of community spread activity is taking place in the county where your nursing home is located. And unfortunately, for many of our counties, we are at a high community spread rate, which means we have to be much more conservative on visitation than what we would prefer to be. And we know that's a frustration for our families. And certainly as for our residents, it's a frustration for our staff as well, because we feel for the residents and the families who just can't get together. So we're continuing to look at options there, our biggest issue or advantage that we would have would be simply to see the county rates for positivity lower. So that would give us more options to have families and residents be able to interact, we simply can't open that door at a time when our community spread rates are the highest they've ever been.
Q: With regards to COVID-19, how close has Avera been to reaching its testing capacity? Is there enough testing and where does that stand locally?
A: We do have testing capacity, both at Queen of Peace, within Avera, and then we have reference laboratories that we work with. There's a variety of options that we have, in order to do testing, and that volume has grown over the course of the last couple of weeks. And that's put some pressure on the system, we can still process those tests. But what happens typically is that it takes a little longer to get the results back. And that's a challenge, I think for everybody who is waiting for those results. … But we've got to make certain that we've got the supplies on hand and those supplies can be replenished. We're working through the challenges, I guess with that right now. But once we get that resolved here, and I think that will probably be in the next week or so that will also help take more pressure off of the testing system because we can handle the long-term care testing locally. There's different categories based on your level of outbreak and so forth. But that volume is significant. And the cost of that is significant, both from a dollar standpoint, plus just the wear and tear on people having to be potentially tested twice a week. And so that's why we'd certainly like to see that community spread rate go down that would have a very definitive positive impact on our nursing.
Q: As it pertains to your position, and in covering these two regions and now that you’ve done this for a few months, what is your view on this arrangement overseeing the Mitchell and Yankton regions?
A: Well, ultimately, that'll be up to the boards at Avera Queen of Peace and Sacred Heart to make that decision. From my perspective, I think it's very much possible. It certainly helps that we're both members of Avera and we have lots of standardization that impact both facilities from an operations standpoint. That being said, there certainly are unique things about the medical community and Avera Queen of Peace that are different than Yankton and the Sacred Heart operation. … I think we just want to keep moving forward in a way that keeps people here locally and keeps Mitchell as a medical destination for this region, for the services that we provide. There will likely be some things we'll decide we're not going to provide, that there is better access and volume primarily in Sioux Falls, but for the things that we elect to do, we're going to do them well and we want to make certain that communities are aware of the services we provide.