'An abundance of caution' and Ebola in the US Healthcare System: What is the new normal?

Roosevelt General Hospital (RGH) is a small (24 bed) community hospital based in Portales, New Mexico, USA. RGH serves several towns and communities along the New Mexico/Texas border to include the enlisted and officer population of Cannon US Air Force Base as well as the civilian support and families for air force personnel. The area is also home to multiple retired and discharged military personnel who continue working in various roles as civilian contractors. As the care for the first US diagnosed patient with Ebola played out in neighbouring Texas (October 2014), a patient presented to the RGH clinic with a fever of unknown origin. Initially, there was a misunderstanding between the clinician and the patient regarding a recent international travel history. During the assessment, an ensuing discussion revealed that the patient had been in or near the area where the current West African Ebola outbreak is ongoing approximately 10 days before the onset of his fever. While it was later determined that the patient was not infected with Ebola, the fact that a potentially infected patient had entered the hospital and had been in close contact with visitors and clinicians alike was disturbing to staff and administration. The continued operation of this hospital was and remains critical to the communities served. This story focuses on a local effort to manage a local concern relying on recent and historical emergency planning and preparedness efforts.

Critical access hospital chief executive officer turnover: implications and challenges for governing boards.

Small rural hospitals, categorized as critical access hospitals (CAHs), are essential to the provision of health care in rural areas of the United States. Critical access hospitals, however, are faced with numerous challenges to their survival that are unique to their role as a rural health care provider. One of the most significant of these challenges involves the retention of well-qualified chief executive officers (CEOs). Following an assessment of the negative implications associated with CEO turnover, the study utilizes survey data obtained from CAHs experiencing CEO turnover to suggest strategies that can be implement by CAH governing board to retain CEO leadership and mitigate the negative impact of CEO turnover. A key issue identified by the authors involves the critical role played by CEO-board relationships and the need for board leadership to create a culture and environment that promotes a strong working relationship and clear expectations between the CAH board and CEO.