Regional Chief Medical Officer, Coastal Region, Mark Eggena, MD, PhD

A Regional Approach to Delivering Care

By Mark Eggena, MD, PhD, who serves as both the chief medical officer for Pen Bay and Waldo and the regional chief medical officer for the Coastal Region

Early in 2023, MaineHealth grouped its hospitals and medical centers into three geographic regions: Mountain, Southern and Coastal. One thing has become clear: the regional structure is an effective way to improve how we deliver care to our patients and our communities.

There are three regions, and Pen Bay and Waldo are in the Coastal Region along with LincolnHealth and Mid Coast Parkview. Each region has its own president and leadership team working closely with local health system presidents and the system leadership team. Our work is focused on aligning resources to improve quality, increase efficiency and extend services to provide care close to home.

A number of early wins have increased confidence in the regional approach. These include regional call agreements, a float pool of nurses serving multiple hospitals and the purchase of ambulances to provide inter-facility transports to get patients to where they will receive the best care.

Reducing Call Burden

Coming out of the pandemic, provider burnout was high everywhere in the country for many reasons. We are not immune to that. One way to combat provider burnout is to decrease the time spent on-call. By taking a regional approach, where one provider is on call for two or more hospitals, we are able to reduce that call burden significantly. This has proven very successful for the orthopedists at Pen Bay, Waldo and LincolnHealth. Instead of being on call every other weekend, the orthopedists now might be on call every one in six weekends. They have more evenings and weekends free. This will have a tremendous impact on improving their work/life balance and recruiting providers. We are now looking for other opportunities to implement a regional approach to call in many other areas including ENT and Ophthalmology.

Inter-facility Transports

Locally, ambulance services have traditionally focused on 911 calls, which has proven to be a challenge when we need an inter-facility transport. Recognizing the need for a more efficient approach, the PBMC emergency department has helped lead a regional effort to improve inter-facility transport. The goal is to guarantee the ability to transport patients by ambulance in an expedited timeframe. Nancy Jackson, RN, the Emergency Department nurse director for Pen Bay and Waldo, and her team developed an inter-facility program in collaboration with NorthStar, a MaineHealth ambulance service that traditionally served Franklin County. NorthStar quickly acquired ambulances for the Pen Bay and Waldo fleet and then set out to hire paramedics and emergency medical technicians. The new team completed its first inter-facility transport in mid-February. The initiative has already yielded remarkable results: The percentage of patients waiting more than three hours for a transfer out of the ED has been reduced by 25%.

Float Pool

The float pool of nurses that Chief Nursing Officer Ellen Leone is piloting is a success in the making. It consists of a dedicated group of nurses who commit to a flexible schedule so that they can be assigned to where they are needed most on any given day. Although it’s early, indications are that this approach has had a significant impact on our ability to respond to the ongoing labor shortage to ensure that patients receive the high quality of care they deserve.

Summary

When we talk about regionalization, we have been a leader in this since 2015 when Pen Bay and Waldo came together as the Coastal Healthcare Alliance. So we’re ahead of the curve, and now we’re continuing that regionalization work with LincolnHealth and Mid Coast Hospital.

However, I think that the success of operating as a region is about much more than specific changes. We have overcome the tendency to compete with each other for staff and patients and are really acting more like collaborators rather than competitors. Working on a regional scale allows us to bring everyone to the same table, all working together for what’s best. We’re all focused on aligning resources so we can keep our communities healthy and deliver the highest quality of care, close to home.