BY: PATRICIA CORRIGAN
Like many rural hospitals across the nation, Carrington Health Center, a 25-bed, critical access hospital in North Dakota, is more than just a place to go for medical care. It is also an indispensable economic and cultural hub for Carrington, a farming community about two hours west of Fargo.
Small hospitals like Carrington, linchpins for communities across the Great Plains, contributed about $1.8 billion to the state's economy in 2008, according to the North Dakota Healthcare Association, which also notes that hospitals in towns like Carrington are usually either the largest- or second-largest employer.
Carrington fits that description. The hospital, part of Denver-based Catholic Health Initiatives (CHI), is the second-largest employer in Foster County, trailing only the Dakota Growers Pasta plant. In addition, while many rural hospitals are struggling through a tough economic climate, Carrington is not only surviving — it is thriving, said Mariann Doeling, the hospital's executive vice president.
"We have to make sure we keep our services alive, that our hospital is here 25 years from now," said Doeling, 53. "That is what I want for the hospital, and for the people of Foster County."
Reared Lutheran, Doeling said she keeps in mind every day that Carrington Health Center is a Catholic hospital. "When a non-Catholic comes into a facility to manage a Catholic hospital, you need to understand what it means to be a Catholic-sponsored organization," she said. "I meet with staff on a regular basis to have conversations on just that topic."
Carrington Health Center, built in 1916, was leased in 1941 to the Presentation Sisters of the Diocese of Fargo. After years of managing and expanding the facility, the sisters in 1980 joined with Catholic Health Corporation of Omaha. Sixteen years later, the Presentation Sisters, along with two other Catholic health systems, formed the corporation known as CHI, a health system with 72 hospitals in 18 states.
"For the longest time, the sisters roamed the halls here, and I often heard from patients and visitors that it just was not the same after the sisters were gone," Doeling said. "Now I tell my staff that we are expected to be the hands and feet of Jesus. I tell them that my expectation is that when you walk the halls, you are the sisters. That changes people's perspectives."
Doeling added that in addition to following Catholic policies in the hospital, Carrington Health Center also does community outreach, including a faith-in-action program that offers transportation for the elderly and an anti-violence initiative designed to reduce underage drinking. Carrington Health Center also makes it clear that the hospital cares for the poor, she said. "That is our mission. With the downturn in these economic times, we have seen an increase in charity care this year. We expected that, but I wonder sometimes if it weren't for us, a non-profit hospital, who would take care of the indigent?"
The Dakota Conference on Rural and Public Health honored Doeling with the 2010 Outstanding Rural Health Professional award. "Mariann's vision for her organization comes not from a carefully crafted statement posted on the boardroom wall, but from her heart," said Luke Larson, vice president of mission integration for CHI's Fargo office.
"Mariann's leadership style is the kind of a real, genuine presence," Larson said. "Her tell-it-like-it-is personality works in the small, farming community of Carrington where people know each other and treat each other like family. Mariann is open and approachable; not self-consciously, but simply as who she is. This allows others to be themselves as well. That's engaging, enticing, even compelling for those whom she leads."
Foster County is home to 3,447 people. Some 2,098 of them live in Carrington, the county seat. Approximately 8,000 people in rural North Dakota, many of them chronically ill, look to the Carrington Health Center for medical care. Designated as a critical access hospital in 2001, Carrington Health Center employs 261 individuals, including family practitioners and a nursing staff cross-trained in all areas of health care. Specialists from the region rotate shifts in the clinics and in the hospital.
In the 2010 fiscal year, Doeling said, Carrington Health Center posted a positive operating margin in the single digits — a noteworthy fiscal accomplishment when compared with other critical access hospitals in North Dakota. In fact, a study two years ago, before the worst of the national economic downturn, showed that the average critical access facility posted a negative margin of 1.4 percent.
Doeling attributes the hospital's solid financial performance to a number of factors — a wide range of services, including high-tech imaging such as CT scans; a collaborative relationship with top officials in the city and county governments; and a strong bond with employed physicians who recognize the importance of the hospital to the community.
"One key part of our philosophy is physician alignment," she said. "To be successful, you must have a very strong bond with physicians. You have to have their buy-in, so that they understand just what this hospital means to the community. I know our physicians understand our mission and vision for this hospital."
Though its capital budget is relatively small, Carrington Health Center boasts modern equipment such as mobile magnetic resonance imaging. These high-tech additions keep members of the community from driving an hour or so to seek medical care at hospitals in larger towns.
"We provide top-quality care," said Doeling. "The residents of our community know that. We do these types of ancillary services so that they can stay close to home. They don't need to go anywhere else."
In 1996, Carrington Health Center agreed to take over the ambulance service from a struggling Foster County. While the hospital has maintained this important service since then, tight budgets have prevented any significant upgrades in equipment. Doeling worked closely with local elected officials to include a mill levy on the ballot this fall. She said that would not have happened without the cooperative relationships she has forged with those men and women.
"We could always maintain day-to-day operations, but we never had the capital we really needed to upgrade this service," Doeling said. "To me, this was a community need — not just a Carrington Health Center need. This will help to support the purchase of a new vehicle."
In addition to her duties at the hospital, Doeling is working with the Centers for Disease Control to organize the agency's Healthy Communities program in Carrington. She is part of a national initiative studying the switch to electronic health records. And Doeling is particularly proud of the hospital's volunteer department, run by Dorothy Fenske for the past 20 years. With 264 members, the hospital auxiliary is one of the state's largest.
Carrington Mayor Don Frye credits Doeling with moving Carrington forward. "Mariann is a progressive person who looks to find solutions so we can build our community," he said. "Her ability to work with all types of government agencies and private organizations is outstanding. Because of Mariann's leadership, and the respect for her in this community, the county and the city are more involved than ever before in helping the hospital."
Doeling speaks openly about challenges she faces, among them a request for a dialysis machine, which is too expensive at this time. "We have to be realistic about what we can do, weigh what services we will offer that will benefit the most people versus what we are being asked to provide," she said. "Also, I have a doc who says that he will retire in six or seven years, and I fret about not being able to recruit a new physician to replace him. We are looking for innovative ways to 'grow our own,' but over the past 10 to 15 years, North Dakota has seen a huge out-migration of young people. We are all trying to entice young people to come back."
Doeling was born 25 miles from Carrington in a rural area. When she enrolled in nursing school at Jamestown College, she was helping her husband, Gary, operate a dairy farm.
"One day when our youngest was in kindergarten, my husband asked if I were still interested in pursuing a career in nursing — a lifelong dream of mine," recalled Doeling. "I said I absolutely was. One week later, I was enrolled. There I was, with three boys and a husband, and I drove back and forth to class — 90 miles round trip — for four years, and I've never looked back."
Doeling earned her nursing degree in 1995. She started work as a staff nurse at Carrington Health Center, then moved into middle management. She worked as clinic director, then chief nursing officer and risk manager. In 2006, Doeling was named the hospital's top administrator.
"My clinical background and my work running the dairy farm have helped me in my current job, but it took me a good three to four years after leaving hands-on nursing to get over that I was no longer what I thought of as a nurse," Doeling said. "Still, I think I am a pretty good administrator. When discussing evidence-based practice and quality indicators, I understand what is being talked about. From inside and out, I know the job, and now I don't have to rationalize anymore than I am not a nurse."
"Mariann takes a proactive versus reactive approach, and that is so important in a small, rural health care setting," said Brenda Rask, vice president of operations at Carrington Health Center. Rask worked with Doeling when the two were acute-care nurses at the hospital, and Rask works with Doeling now in administration. "She is very committed and very involved in health care in the community and at the state level, and she has a national role in practice management through Catholic Health Initiatives. I truly admire her wealth of knowledge, in health care and beyond."
Doeling, Rask said, is an honest person who does her best at whatever she is doing. "She expects that in other people, as well," Rask said.
For her part, Doeling described her leadership style as collaborative but demanding.
"I think I'm pretty easy to work with," she said. "But I do like to hold people accountable because I want us to be successful."
Conceding that she is not sympathetic when anyone complains about having a bad day, Doeling described herself as a "rah-rah, go-getter" type who is "not easily persuaded, not easily fooled, not easily buffaloed" and immune to the idea that any task is too difficult.
"I will see any project through to the end, and I want the buy-in from people around me," she said. "I know my facility, my staff have longevity here — many of them are from Carrington, and that helps a lot — and I think I understand not only CHC but the relationship of the facility to the community. Above all, I want Carrington Health Center to be known for our quality of care."
PATRICIA CORRIGAN is a freelance writer in San Francisco.