Amanda Wilde (Host): In rural areas, access to OB-GYN care makes all the difference in patient outcomes. Today's guests share insights from the front lines of ensuring accessible, high quality maternal care in rural communities.

Dr. Garrick Slate: This is the Obstetrics Podcast from OB Hospitalists Group. I'm Amanda Wilde. And with me are Brandon Reece, Executive Director of Physician Practices at Magnolia Regional Health Center, and Dr. Garrick Slate, an OB-GYN clinician with OB Hospitalist Group's Maternal Health Access Solutions Program. Welcome to you both. 

Thank you.

Brandon Reece: Thank you.

Host: Brandon, we want to hear how at Magnolia Regional Health Center you had to employ innovative solutions to ensure women in that community had access to care close to home. First, can you tell us a little bit about your hospital and the community it serves?

Brandon Reece: Absolutely. Magnolia Regional is a 200-bed stand-alone hospital located in Corinth, Mississippi. We serve a six-county region that spans northeast Mississippi and Southern Tennessee, mainly a rural community, but we do offer a level three trauma center as well as two separate residency programs for both Internal Medicine and Emergency Department Medicine. We also have a Cardiology Fellowship and employ over a thousand employees and 80 plus physicians.

Host: So even though we hear the word rural, a six-county region is a pretty large section to be serving. What were some of the biggest challenges the hospital was facing in OB-GYN care?

Brandon Reece: So, being in such a rural community, again, it's six counties, but not very much opportunity for a metropolis, if you will. But our challenge was we employed two OB-GYNs in our community. And call coverage is a major challenge in that space. And so, we needed a third in our rotation. And we were covering that through locums coverage. And a challenge we were having with that is locums were difficult to find. There was a rotation of them that was inconsistent, and it made our responsibility of providing 24/7 call availability a difficult ask on a regular basis.

Host: And in tackling these challenges, what were some of the barriers you encountered and how did that impact day-to-day operations?

Brandon Reece: One thing, the OB service is really a small pool of candidates each year that are either graduating from a residency program or looking to move their practice. It's also difficult to recruit to rural Mississippi. If you didn't grow up here or have a family connection here, getting candidates to even come take a visit to check out the hospital and the surrounding areas, it proved quite challenging.

And so, as we were keeping our focus on making sure the longevity of the service line continued into the future, we had already explored OBHG services and their hospitalist world prior to making the move. But it wasn't until we had a departure from one of our OBs that ultimately led to more urgent requests for them to partner, and that's really what got things moving for us.

Host: I see. So, I was just going to ask if there were any moments that highlighted the urgency of the situation, that was it.

Brandon Reece: Absolutely. One of our OBs that didn't grow up here got married and moved back to her hometown. 

Host: So, this situation does become urgent. How did you begin exploring solutions and what did you ultimately end up doing? You kind of had to think out of the box, I believe.

Brandon Reece: Well, we really did. And I think from an OBHG's perspective, we were a unique partner as well because we weren't just looking for someone to handle call coverage as a hospitalist at the Labor and Delivery Department of the hospital. We needed both a full clinic coverage where patients would be seen on a scheduled and unscheduled basis, as well as the urgent need of emergency room call, scheduled deliveries, and the such. So, we were unique in that the ask was a full service OB-GYN.

Host: And how did you start implementing this solution?

Brandon Reece: So, OBHG really came to the rescue, if you will, and offered that service. It was kind of new in their program catalog, if you will. But they initially were able to recruit one physician to us that actually was a physician that was just wanting a change in their practice. They happen to be in Mississippi already, had a positive reputation, and just a different change of environment and pace.

So, we were able to recruit them to join us through OBHG and continued partnering with them to find locums coverage through their ambassador program. And we as well had some connections that some longer term OB-GYNs that had been working with us on a as needed basis. So, through the course of the transition, which lasted probably 18 months, we were able to work with them collaboratively to make sure we never had a gap in call coverage, and ultimately were successful in recruiting three OB-GYNs to permanently be part of our Magnolia team.

Host: So, that's a victory. And once you stabilized accessibility to care, how did you see things start to change?

Brandon Reece: The biggest thing that we're celebrating here at Magnolia is some of the quality improvement metrics. We have seen a drop in early elective deliveries, as well as primary C sections. But I think that's directly due to the experience of the physicians that we were able to recruit to join Magnolia and they're not as quick to ship a patient. They're not as quick to think they can't handle something, and the patient care and the perception of the community has definitely improved.

Host: And Dr. Slate, I want to bring you in here. You were involved in the solution that Brandon's team at Magnolia put into place. Can you talk about some of those first steps you took to integrate with the hospital team?

Dr. Garrick Slate: Absolutely. As Brandon had alluded to, the maternal health access solution portion of OBHG, it was a fairly new topic that we were trying to roll out. The country has been facing increasing numbers of maternal healthcare deserts across the country, really impeding access to care. And Brandon and his team were well ahead of the curve on understanding how this could be a problem.

When he contacted us, really the first key is to understanding the true needs of the hospital. And they've been an amazing partner. When we were getting ready to set up, the first thing is to understand what is their footprint, what do they have for infrastructure, how do their systems and workflow processes work? And I have to say, they already had a clinic that was set, they had a clinic manager, they had a floor manager for Labor and Delivery and Women's Services. So, it was really sitting down and saying, you know, "Where have you been?" "Where are you now?" "And where do you need to go? Where do you want to go in the future?" And starting to integrate into their vision so that we had a shared vision as a team.

Host: The collaboration really melded well. Brandon, would you like to add anything to that?

Brandon Reece: Yeah. I think the reference to the healthcare desert idea, as a small rural hospital, we feel a huge responsibility to help patients not have to drive over an hour for healthcare services, and that's what we were facing in the OB service if we were to lose our physicians and no longer be able to provide OB care. And the partnership, I think, the timing worked very well for us. Like Dr. Slate alluded to, we were early in the setup for what they were doing in both the clinic and the hospital space, but it has been nothing but positive for us.

Host: Dr. Slate, what does that collaboration between the administrators at Magnolia and the OBHG team, what does that collaboration look like?

Dr. Garrick Slate: Well, you know, I think the first thing when we started there, I was on site. I actually spent several days on site at the hospital myself. I met with Brandon. We sat down and discussed really the critical needs and concerns of the department from a hospital standpoint, not from a direct, you know, interdepartmental issue at the moment. But how did this have to look in order for it to be successful?

One of the things that I think hospitals sometimes see is when you have just a locum tenens model, they perform a vital role, but oftentimes locum tenens are not really vested into a particular location because they can go to any location. Our goal was to bring in three physicians who really became vested not only in their job that they were doing, but to the community and to the hospital as a whole.

How do you integrate some physicians who don't necessarily live locally to be perceived and to act and work as though they do. And once you do that, I think you begin to get success and success at the patient level, understanding that we're going to be seeing the same physicians over and over and they're going to be able to have a continuous role within the hospital and among the hospital staff. Names get known, roles get known. And that really allows the workflow around women's care and the quality of women's care to move at a higher level.

Host: Brandon, would you like to add anything to that point about collaboration?

Brandon Reece: The biggest thing for me has been access to their leadership. If I call Dr. Slate's cell phone, unless he's delivering a baby or with a patient, he answers without question. We've had some evening discussions. Other members of his team, we have a regularly scheduled meeting with them that, more often than not, ends up getting canceled because we've already handled the things that were potential fires throughout any given week.

So, I think one of the coolest things that we've done is, once we got the full team in place, we hosted an open house here at Magnolia just to introduce the docs. And remember, they don't live here. So, we scheduled it on a day where two of them were doing a handoff, and the third one agreed to drive in more than an hour and a half away. And it gave the community a chance to meet them, to see these were the OBs that we were going to have here. They were going to be consistently present. One of the three of them would always deliver the babies and just their partnership in that and helping facilitate that open house, it meant a lot to Magnolia as a system and to the relationship we have with OBHG.

Dr. Garrick Slate: One of the things that I usually talk about when I'm bringing on new team members is, you know, we talk about collaboration. And as Brandon just said, if you don't have communication, you don't have a good collaboration. So, I make myself available to any of our clinical partners. They have cell phone numbers, they have email addresses, they have any contact info that they need. Because sometimes things happen, and you need to be able to talk quickly and efficiently to solve issues, and the ability to have this communication has allowed, I think, this collaboration to flourish.

Host: So with the success of your team, how have you seen these changes impact the experience for patients?

Dr. Garrick Slate: An interesting thing when you're doing this, especially for the maternal health access solution programs is we tend to bring in physicians who have been in solo private practice for years. We've been covering their practice 24/7, 365, you kind of do things your way. And it's not necessarily a bad thing. It's just what you've gotten used to doing and running in your business. When you bring in multiple individuals together as a team, you start to uncover some of the differences in practice. You discover differences in patient approach. And what I've really enjoyed in this is we were able to sit down as a group, sit down with the hospital, start looking at quality metrics. And when you do that, you start to improve the overall healthcare outcomes. So being able to really look at multiple practices across the spectrum, both in the clinic and in Labor and Delivery inpatient setting, you really can make an impact that patients are getting a standardized, evidence-based medicine level of care.

Host: Brandon, from your perspective, how has the partnership impacted the quality of care delivered to patients?

Brandon Reece: So, I like to judge this from the patient perspective, and as we were going through pre-transition and, again, some of the transition where we had different faces coming and going, our patient satisfaction scores were in the toilet. And I haven't even shared this with Dr. Slate yet, but we just wrapped up the fourth quarter of the calendar year and got those results. We are now, from a patient satisfaction perspective, in the 90th percentile in patient satisfaction scores. That's the first time in my tenure of approaching four years, but it's been a long time since Magnolia has seen anywhere near those satisfaction levels.

Host: Dr. Slate, with those wonderful numbers, what still needs to be done in general to improve maternal and women's health services in rural areas?

Dr. Garrick Slate: It's really great to hear those numbers and know that the team is doing well. We're not implementing any new changes, but what we have been doing is going back. Looking at labor and delivery protocols, looking at protocols for inductions, for example, management of postpartum hypertension, management of postpartum hemorrhage. A lot of the topics that are generally considered obstetric emergencies, but really drilling down and developing new evidence-based medicine protocols that are shared between the labor staff administration and the clinical members of our team to ensure that we're always trying to improve on maternal safety. You know, maternal morbidity and mortality is much higher in this country than it should be.

And so, the first steps are looking at where you've been before, where you're currently at, and how you can make those numbers even better. And so, we've put through quite a few protocols, I think, Brandon, and we're still improving.

The other thing is I also serve on one of their quality improvement committees. And so, we look at charts, we review and audit charts to ensure that the clinical care that's being delivered is being delivered at the highest level that we can do.

Host: Lastly, for you, Brandon, what advice would you give to other hospital leaders who are experiencing challenges similar to those you first described?

Brandon Reece: I highly recommend partnering with someone. Our experience with OBHG was unique because this is what they do. OB is their bread and butter business, and they've got the connections across the country with physicians of whether it's new grads or people in the later ends of their career.

If you don't have a vision for how you expand the longevity of your program by looking over the horizon to see what's coming, you can't catch up if you get behind. We were so close to losing our program if we would have had one more departure. We had nothing but locums in this community. And so, partnering with someone early, recognizing that healthcare deserts do exist. And if you want to protect your community, it's best to get ahead of the game and start partnering with someone earlier to increase that longevity. 

Host: Well, thank you both for your insights and providing valuable takeaways for improving women's healthcare access in your community. This is really positive change in very challenging times.

Brandon Reece: Absolutely.

Dr. Garrick Slate: Thank you. It was a pleasure to be here.

Host: That was Brandon Reece of Magnolia Regional Health Center and Dr. Garrett Slate of OB Hospitalist Group. For more information about improving access to women's health care in rural hospitals, visit obhg.com. If you found this podcast helpful, please share it on your social channels and make sure to check out the entire podcast library for additional topics of interest. This is the Obstetrics Podcast from OB Hospitalist.