An Interview with Darrold Bertsch

Darrold Bertsch, serving as CEO of both Sakakawea Medical Center, a Critical Access Hospital, and Coal Country Community Health Center, uses his uncommon role to improve healthcare in his rural area. In his position, Bertsch explores ways to more efficiently allocate resources and services between the two organizations to improve patient care. His more than 38 years of healthcare experience, combined with his involvement in local, state, and national boards, give Bertsch the insight to navigate this innovative shared leadership position.

How do the two facilities (Sakakawea Medical Center and Coal Country Community Health Center) make it work to have a single CEO for both organizations?

The two organizations, their governance, providers, and staff have truly embraced a common vision which is "Working together as partners to enhance the lives of area residents by providing a neighborhood of patient-centered healthcare services that promote wellness, prevention, and care coordination."

Can you describe the history of the two organizations and their roles in the area's healthcare?

Sakakawea Medical Center (SMC) is a 25 bed Critical Access Hospital located in Hazen, North Dakota. The hospital is a nonprofit corporation that provides a variety of services, in addition to hospital services, including a Rural Health Clinic (RHC), home health, hospice, and basic care services.

Coal Country Community Health Center (CCCHC) is a Federally Qualified Health Center (FQHC) located in Beulah, North Dakota. Prior to receiving the designation as an FQHC, CCCHC was a clinic owned and operated by the former MedCenter One (a Bismarck, ND tertiary hospital). Both organizations are essential rural safety net providers, offering primary care services to the residents of Mercer, Oliver, and Dunn counties.

How did this shared CEO arrangement come about?

Not too many years ago, a competitive spirit existed between the two organizations. Both organizations were vying for market share, services, and staff, which resulted in the duplication of services and an adversarial relationship. When the prior CEO of the health center and the health center governing board opted to end their employment relationship, the boards of both organizations, with the encouragement of the health center medical director, opted to pursue an interim shared CEO relationship. This interim relationship worked well, resulting in improved care, more efficient utilization of resources, and an improved financial position for both organizations. This success prompted the boards to pursue continuing the relationship on a longer term basis. The organizations engaged a consultant and worked hand in hand with HRSA (Health Resources and Services Administration) and other regulatory agencies to develop a structure that continued to meet community needs in the most efficient and cost effective manner, while accommodating regulatory requirements.

What are some advantages to shared leadership?

We share resources and utilize the strengths of both organizations in the care we provide collaboratively to our patients. I'm working with a group of very talented providers and staff, offering them guidance and the resources they need to do their jobs and excel.

What are some disadvantages?

When individuals or organizations work together towards a common goal and the result is improved patient care and outcomes for our patients, in my mind there are no disadvantages.

When individuals or organizations work together towards a common goal and the result is improved patient care and outcomes for our patients, in my mind there are no disadvantages. Because in the end, that's why we exist as healthcare organizations.

What challenges have you faced being CEO of two organizations?

As is the case for many individuals in leadership, it's finding the time to do all of the things we'd like to do. Though some may think that sharing a CEO may result in a conflict of interest, in reality if we always put the patient and the community needs first, that doesn't happen. As a friend of mine who assisted us in this collaboration once said, "Together we are greater than the sum of our parts!"

You mentioned conflict of interest. How do you deal with conflict of interest that may arise between the two organizations?

The organizations do have a mechanism in place to deal with potential conflicts of interest by excusing the CEO and discussing any potential conflicts in executive session. We have an integrated governance which helps ensure transparency and helps us work toward a common vision. Each organization ends up stronger.

How has this partnership improved healthcare in the area?

The collaboration between SMC and CCCHC has provided many benefits to healthcare delivery in our area. Our relationship has provided a community framework for conducting a collaborative community health needs assessment involving not just our organizations, but also the local nursing home, ambulance service, and public health agency. The results of this community health needs assessment were then used to develop a collaborative strategic plan that included all of the organizations, who meet periodically to update each other on progress towards the individual organization initiatives. This work has also resulted in the development of a collaborative community health improvement plan, which incorporates behavioral health and community care coordination. We meet on a periodic basis to assess progress and adjust initiatives as necessary. This cooperative planning has resulted in improved patient care and improved health for the population we serve.

Have you found there has been increased collaboration between the two facilities due to your leadership position?

Absolutely, but it's not because of me. It's a result of our boards, providers, staff, and community embracing our collaboration and what we are doing. I just need to make sure to keep us on track and provide the direction and resources that are needed.

Would you recommend other rural hospitals to share their top leadership?

In the end, healthcare providers should work together to optimize resources and services. But it's not a one-size-fits-all solution — each community should work together to develop a healthcare delivery system that meets the needs of patients. In the opinion of our organizations, it's through a shared CEO and integrated governance model. The integration of governance is as vital as having a shared CEO in order to remain focused on a common vision. Each community needs to evaluate what will work best with for that community. I encourage people to work together the best they can to avoid duplication of services, but that might not necessarily mean sharing CEOs.

You've been very involved in organizations at the state and national level. What inspires you to be involved in rural health policy issues and take a leadership role in organizations representing rural interests?

Just because we live in rural areas of this country, we shouldn't have to settle for anything less than the best healthcare services.

I guess part of it is that I live in a rural area and have done so for the better part of my life. I've always worked in healthcare delivery in rural areas and it is something I have a passion for. Providing healthcare in rural areas is a challenge for a variety of reasons. It's tough out there! Organizations often struggle to make ends meet and provide the services needed in their communities. Just because we live in rural areas of this country, we shouldn't have to settle for anything less than the best healthcare services. If my involvement at the local, state, and national level results in better care for the people in the community and state I call home, then I will do what I can.

Do you have any final thoughts to share with our readers?

Though healthcare providers always need to be cognizant of regulatory requirements, we should all work together to optimize the programmatic benefits of the services provided by our organizations. As the saying goes, in the end, "local challenges need local solutions developed by local people." Nobody will do it for us. We have to take the initiative ourselves. I'm blessed to be in a community where I can be a shared CEO. But in no way is this about me. It's about building up a team and working together. A leader can't do this without a team. The credit is owed to the governance, staff, and board. I'm extremely proud of our organizations and what we've been able to accomplish.

Opinions expressed are those of the interviewee and do not necessarily reflect the views of the Rural Health Information Hub.