July 2025 Membership Luncheon

Robert "Bo" Cofield, COO of Northern Arizona Healthcare, discussed the organization's strategic plan, focusing on quality clinical outcomes, patient experience, and community needs. He highlighted a 10% reduction in turnover rates through culture, compensation, and growth opportunities, including $5,250 annually for tuition reimbursement. Cofield emphasized the importance of modern facilities, citing a renovation of the emergency department and the impact of new space on recruitment. The organization is also developing a new strategic plan, engaging the community through listening tours and advisory councils. Financial stability and the impact of potential Medicaid cuts were also addressed.

Transcript

Mark Colletti: 0:09

So it is our our speaker also today is from Northern Arizona Healthcare. I'm proud to introduce Robert "Bo" Cofield, the COO, Chief Operating Officer for Northern Arizona Healthcare. Thank you. One thing, please hold your questions till the end. Sudden, get through, and then we have time for that.

Robert "Bo" Cofield: 0:36

Alright, thank you very much. I appreciate it. And thank you so much for having Herman having me here today. Sorry, I've still got hospital on the mic here. And greatly appreciate the opportunity to share some of the great things that we've got going on at Northern Arizona healthcare. And thanks to Rick Lopez for inviting me to speak here with you today as they pull up my presentation. Share with you a couple of things, one, some updates on some fun stuff that we've got going on, but secondly, also share with you an endeavor that we've been undertaking now. We're about nine months of developing a new strategic plan for Northern Arizona healthcare so that we're sure we're aligned with what the community needs as we as we go forward, any guess we have a clicker here? Might work, might not. Is it working? It also might not be on. So there we go. So if you'll just push a button for me when I ask you to Yeah, Okay, sounds good. So again, my name is sorry. My name is Bo Cofield, and I'm the Chief Operating Officer Northern Arizona healthcare. I've got responsibility for our clinical operations across all of Northern Arizona, so our two hospitals, our freestanding emergency department, or all of our clinics across northern everywhere between here and there, I've been here about 20 months now. I moved here from Kentucky, and I'm absolutely having a blast, first of all, living in this wonderful community, and then secondly, working at an organization that is as committed to its community as Northern Arizona healthcare is, and it's been a lot of fun working with the team, getting to know Northern Arizona as well, and say, Well, I've moved here from, I should just say I moved here from the southeast, because that's where I've lived virtually my entire life, and I'm really glad to be rid of the humidity, as my kids say when I call them, how's the weather? 95 to 95 and we certainly don't have that here, so it's wonderful. So what are we working on? And I'll move through this relatively quickly to get to the strategic plan. We are always and consistently focused on quality clinical outcomes and quality patient experience. It's amazing the quality of healthcare that is provided in a community of this size, and that is not customary across the country. My last hospital responsibilities were in Columbia, South Carolina, big metropolitan area, about a million people. We have more hospitals than you could shake a stick at right. But once you would get outside of Columbia, you really lost the opportunity to recruit and retain quality employees and quality medical staff. We don't have as much of an issue here as we do in some parts of the country, particularly in the southeast, where I come from, and so they're solely focused on making sure that we're taking great care of patients every day. We benchmark very well, but I'll use an example. You know, we had a patient fall inside of our hospital this week. That is unacceptable, absolutely positively unacceptable. So we're continuing to figure out ways that we avoid providing harm to patients that they shouldn't get. It's a fact of what it is that we do, but it's not acceptable to us, and I was fortunate enough to inherit an organization that is focused on those things. We continue to focus focus on recruitment and retention of both colleagues and providers. Our turnover rates are now down below national norms by about 10 percentage points. That is because we focused on three things. First and foremost, culture. Secondly, money, money does make a difference. And thirdly, growth and develop, so not just compensation, but investing in our colleagues. About, I don't know, three months ago, Steve, we were here in this building celebrating 50 scholarships to our colleagues to support their growing education. Every employee who's with us for at least six months gets $5,250 a year towards tuition reimbursement. Has to be something that will probably benefit the community. We're not going to send a nurse to geology school unless we have a need of facilities for geology as we build a new hospital. Right? We might, we might make that decision, but we continue to focus on that. We also continue to focus on recruitment. Our largest success in recruitment, quite frankly. Has been in the Verde Valley, bringing specialists to that community who left both pre and post COVID. Love them retired, but we now have a full Hospital in Cottonwood Arizona. When I got here in December of 2023 it was about a half to two thirds full. We staffed it up with physicians, we staffed it up with nursing, and how every bed is open in that community, which creates capacity here at Flagstaff Medical Center. So these two things work dynamically as well. We continue to work on relationships, so not just with the community, and I'll talk a little bit more about some of the things that we've done there as we get into the strategic planning conversation, but also clinical relationships. So we've established a clinical relationship with City of Hope, great Cancer Center. They do more bone marrow transplants at City of Hope facilities than anywhere else in the country. Fantastic, right? And it's just right down the road here in Goodyear, we have a relationship now where we can refer them patients, if we have the ability to apply a chemotherapy agent that is safely delivered in this environment, that patient is coming back here to our oncologist and being cared for in their community. We're working on relationships across the board there. We continue facility and infrastructure. You all know, you were great supporters. We appreciate that of the desire for a new hospital in this community. We're regional referral Medical Center. Talk about that again, when you the strategic plan, but we know that's not we're not putting shovels and grounds yet, but guess what? That's five to seven years away. At this point in time, we can't require our patients to deal with some of the facilities that we've got today that are not modern. This has actually helped with recruitment and retention. So the perfect the best example of that so far is opening the primary care practice across around buffalo park in the ambulatory center right by our guardian station up there. This time last year, we had nine primary care physicians in our Oak Street location. We were having a very difficult time recruiting the minute that we had not just drawings, but we had activity happening up there to build a primary care physician. We signed, not the minute, but within a week, we signed two primary care physicians. By the end of this calendar year, we'll have 17, all because of new space. Now, it's a great place to live, great place to practice, but we were getting no traction on recruitment until we showed them a space where they could be their best, as it were. So you know, when we're having company over, don't we all just don't clean up our living rooms and our kitchens. There's a point at which your kitchen can't be cleaned anymore, right? And it just is what it is that's kind of what we're living with with some of our facilities. And so we continue to work on that they on the current, probably the biggest project that we have going inside of our four walls right now is the emergency department at Flagstaff Medical Center. That is a complete renovation. It won't create a whole bunch more capacity, but it is a renovation fit and finish to bring it up to modern standards that will also help us recruit and retain but make the patients feel as though they're in a much more we won't have that 1970s era green tile that hospitals are known for and replaced with dry wall and nice wood floors and those kinds of things, or fake wood floors. Steve ISIS my facilities, he doesn't want real wood. And then we're continuing to support all of Northern Arizona through development of our strategic plan. If you could flip over to the next slide. So Dave Cheney, first and foremost, wanted to build his team, so he brought me here, brought a couple other folks here. We replaced our chief medical officer with Dr Rachel Levitan, who's from here in the community emergency medicine physician. And so now we've got largely a fully built out team. They've said, next step for us, board, please work with us to develop a strategy for this organization to meet the community needs. Between now and 2030 used to be strategic plans in healthcare for 10 or 15 year timeframes. We actually had a strategic plan that we did in 2920 18. 2019 didn't communicate it widely. That's okay. It is what it is, but it also went up on a shelf in 2020 right? Because our strategy then was just to meet the patients who were coming to us every day. We weren't focused on growth, recruitment, retention, those kinds of things. We're trying to figure out what patient we could shoe on into which unit in order to be sure that they could get the care that they needed if they had COVID, and the first step that they decided upon, along with our board, is, let's, let's do a listening tour to seek to understand, identify needs and align vision with the community. So we started with internal communication external. It was often in the first person, most frequently in the in the first person, and it was facilitated so that we could get the answers that we needed, and frankly, so things didn't turn into arguments about what we were doing or what we weren't doing. It's about what focused on what we need for the community as we go forward, Dave met with every Northern Arizona healthcare department with the medical staffs and open forums created Dave Safety Line. Which are way other additional dialog as well that happens every month. And then building community relationships, we had facilitated conversations inside of the organization as well, little bit outside, but mostly inside, with somebody that you may know, Jason field independent party, facilitating those conversations. We got, what, a 20 page report, Steve, out of that with great feedback from our colleagues and from the community about what we could and should be working on, but also about what we did wrong in the communication very much focused on Proposition proposition 480 we've created physician advisory councils with that. Should also say, well, that's down there. Community advisory councils. Where's Rick? He's here somewhere. I just saw him. He serves on one of those community advisory councils. We have two advisory councils in both markets, north and south, a physician Advisory Council and a community advisory council in both Verde and in in the Verde Valley and in Flagstaff. And then we actually engaged a group called noetic, who helped us with a listening tour where we got 400 plus voices into hey, what can we do better in order to meet the community's needs? That's literally the question that was starting, and both small and large groups, it was quantitative and qualitative. And say, well, there's 80,000 people in Flagstaff. Is that enough? Yes, it is actually. Because as we got to the end, the themes were consistent. We started to hear the same things over and over and over again. Decided that there was a point of diminishing returns. Sorry, I'm an economist by training. That also means I know the social sciences literature. So for these this kind of work, if you get more than 100 you're knocking it out of the park as compared to most peer reviewed published journal articles in the social sciences. So we felt very comfortable that we were getting the right information. Doesn't mean we're done, of course, as well. And now we're moving on to preview and feedback. So we previewed these things with our leaders, our medical staff, and now we're on to community and local advisors, along with our partners, hence me being here today. So one thing that we did for sure is We reaffirmed our mission vision and values. We wanted to be sure that we were still driving towards the right things and doing it in the right way, as we worked with our community and worked with our colleagues. So a mission is why we exist. Well, that didn't change. We continue to focus on improving health and healing people. Our vision, what we hope to achieve, no reason to change. These works, right? Always better care every person, every time, and we do that together. Healthcare is a team sport that's sometimes it's full contact with no pads, like today, when we've got two incredible one incredibly full hospital and one that is getting there and getting there, and then values how we make decisions. And we made a conscious effort to really ask this question hard about whether or not we wanted to change this, because these values came from our colleagues. We call it our employees colleagues. They were developed in 2018, 2019, time frame, and we didn't want to change those without input from our colleagues, so we went to them and said, Are these still the things that we want to be focused on, and how it is that we do we work, do our work, and how we fashion everything that we do? And the answer was yes. So we reaffirmed those visions with missions. Next slide, please. So out of all of that work, we developed four strategic imperatives. The first is to put our people and community first. The second, to advance our path to clinical excellence. The third, to grow our reach, including the construction of a modern regional referral hospital. And I'll get into each one of these a little bit more in just a moment. And then lastly, to achieve financial and organizational stability. So we're just going to stay here on this slide for a while, actually, and we'll tell you that in any strategic planning process I've been in the four other organizations that I've worked with and done a little bit of consulting on is that everybody starts with advancing their path to clinical excellence. Everybody starts with quality and safety. What we heard from the community is that's great. We love it. When we get there, you take good care of us. We don't know what the heck you're doing. We don't know why you're doing it. Can we have some dialog about that? Please? And so that's how putting people and community first. What we also heard from our employees is you treat us like commodities. Can you please pay us fairly? Can you please explain the benefits to us? Can we sit down and have dialog about changes that are happening in the environment, rather than just forcing things down on us? Because guess what, your employees have the best ideas about the ways to do things right. Phone call that I had to leave, was talking with my Chief Nurse before I made a really what would have and she told me that's been a really bad decision about our Med, surg, tele units for this evening. She's on vacation, and I don't want to mess things up while she's gone. And so I got feedback from her, and she said, these are the two other people you need to go talk with to make sure that we're not making a bad decision here. So. Engaging our employees and our colleagues in our decisions. Putting our community first boils down to understanding what the community needs are. So every hospital in America, every not for profit Hospital in America, has to do something called a community health needs assessment. How many of y'all have seen ours? Yeah, I see a few hands we didn't do our job then, and saying, Here's what the data say that we need, and bouncing that off of what our community says that we need. We can do epidemiology all day every day, and say, This is how many cardiologists that we need. But what is the experience in trying to get an appointment for a cardiologist? And by the way, I know it's not good, so not as good as it could be, still good. The number of cardiologists that we have in a community of 80,000 people is pretty darn strong. And so just one example of trying to continue to engage with the engage with the community. The second thing advancing our path to clinical excellence. So we are definitely focused on getting ourselves to what we call zero harm, which is when you come to a hospital, please raise your hand if you'd like to get a bloodstream infection. No one would sign that piece of paper, like when you sign the HIPAA documents and all those kinds of things. No one would say, yes, please give me an infection or I know that this is a risk that conversation before procedures were supposed to for informed consent, but we've got to continue our focus and make sure that we're moving towards zero harm. You got the mechanisms in place for zero harm. That means you also have the mechanisms in place for the best care to be provided, even if it's something that's not truly intervention, and there's a lot of literature and research associated with that. And we're organizing our systems to be able to to be able to do that. You should be very proud of the healthcare delivery system that has been built here in northern Arizona long before Dave Cheney got here, long before will COVID ever got here, long before Steve ice ever got here. This is a high quality healthcare delivery system that benchmarks very, very well to other hospitals our size and communities our size. It also benchmarks very well from as compared to the academic medical centers that I came from before I worked here. So we're very pleased with that strategic imperative, 3.0 grow our reach. Tell a little story here. So you might have gathered this already. I use the literature to make decisions. I use my education to make decisions. And there are three gurus of strategic planning and strategic processes and conversion of strategy into operations in the academic world for healthcare administration, Duncan, Ginter and Swain. And there are three faculty members at the University of Alabama and Birmingham who were fellow faculty members of mine. And one of the things that they say clearly throughout all of their books that they've ever, ever published, and probably on the eighth edition of you know, sort of what Masters in Health Administration students get for their for their strategy education is you don't include tactics in your strategy. And so this came up, putting a hospital into the strategic plan. And I kept on talking, you don't put tactics. You don't put tactics in your strategy. You don't put tactics in your strategy. That comes later, big things, big things, strategy. And Dave leaned over and said, Go, shut up. We put it in there. We get what we want, right? Okay, yes, I will not be so academic here for a little while and let that happen. And we know that growing our reach is something that we absolutely positively have to do. We know that an element of our relationship with the community was proposition 480 and the failed effort to build a modern regional referral center, because we are not just flagstaffs Hospital. We are Northern Arizona's hospital. We would rather have our patients come from verde if they're getting in the back of one of our guardian trucks or in one of our helicopters. We'd much rather have them come north than we would go down to Phoenix, because they can continue their care here post discharge, rather than having to continue going down 17 to south. The other thing that we know, and we had a test case of this, which was building that new primary care practice, it has absolutely positively helped us recruit, not just on the physician side of things, but we had to recruit techs and medical assistance and registration personnel to support all of those providers. Guess what? They saw the space and like, this is going to be a nice place to work. Actually, I can see the mountains out of from my desk. If I'm a registration person, I can see Mount Eldon and mount Humphreys. And so we know that that's the case. There are a lot of technology reasons to have a new hospital as well. So I'm getting ready to give an interview. You all saw the saw the article, hopefully. I think it was last week or early this week, about the mobile MRI that we pulled up on the side of the building at Flagstaff Medical Center. Who wants to go outside to get their MRI? Raise your hand please. Now it's the only option I've got. I'll raise my hand. In all day, every day, but that is the only option we had, was to put it outside in a trailer, because we don't have the physical capacity to put it in inside of the four walls of the existing hospital. We didn't tell a lot of these stories when, when proposition four was just all about we don't have enough beds. We don't have enough beds. We don't have enough space for the technology that is necessary to one take the best care of patients that we can, but to recruit and retain so another example was chatting with one of our frontline nurses in OB and she lives over in the West University, or in the West University side of things, and she said, Well, what's going on with the new hospital? I said, Well, we're just taking a cool off period. What did you think about that? She said, Well, I voted against it because it was going because it was going to increase my commute by 10 minutes. Well, forget about the 10 minutes that you're shaving off going from that point up to bike zap Medical Center. So it's about the same. We agreed on that right away. And she said, Well, why else do we need it? And I said, you have anybody in your family that you worry about having a hemorrhagic stroke. We I always worry about that. So where are you going to go to get that care? Well, flex that Medical Center. Do you want that treated in a minimally invasive fashion? Or do you want to crack your skull and pull that clot out with a hemostat, which is a fancy word for a pair of needle nose pliers? Rather have it minimally invasive? Yeah, that would be awesome, wouldn't it? Guess who we can't recruit here to take care of it in any way other than crack and skull neurosurgeons. Any neurosurgeon who's been trained in the last 15 years at any major metropolitan area has been trained to do that in a minimally invasive fashion. We don't have the space for that technology requires by planning and geography, we don't have a space for that. So even if we put it in today, we'd have to put it outside right not the right thing to do. And so we are focused on this. What goes along with growing our reach, about with respect to the construction of modern regional referral center, is to grow our ambulatory platform at the same rate. So that's why we made the investment in what we call the mesa, which is where our primary care practice. We just got permission yesterday to start using our expanded specialty care practice up there. I don't remember 12, 1315, exam room. 15 exam rooms, to be able to help recruit specialists as well as we move forward, what also is a key component of that is figuring out what the community needs. So going back to that community health needs assessment, we need to utilize that to make the decisions in terms of what it is that we recruit, and what it is that we focus on retaining, and what it is that we build when we build a new hospital, Stephen like to hear me say that because it might require some redesign of the hospital. Of the hospital, but that's a short term pain for a very long term gain, because this hospital is a 50 Year decision at a minimum. And so that growing the reach is not just about the four walls of an acute care facility, but also about growing our ambulatory things as well and meeting the needs of the community where they are. We used to have great relationships and great presence, as it were, in the in the tribal regions, we don't anymore. That has declined over time. We have got to refocus on that and keep people in their community. Work with the IHS, work with Tuba City to figure out how we can keep care local, because we know that that's what we would want if we were patients. And then lastly, strategic imperative. One of the things that has become clear to me, or was clear to Dave, when he got here, and I learned very quickly as well, is that we didn't have a lot of organizational stability. I think somebody walked into Dave's office about 48 hours after he's been there. He said, Well, you beat number four. He made it 48 hours before the CEO has moved on, right? So we've got a stable operating environment from a leadership perspective, which permits stability in our clinical operations, and we'll continue to focus on that stability, that organizational stability creates financial stability. We have to be financially viable. I'm sorry, but healthcare is a business at some level. We have to generate margins in order to be able to invest in that biplane angiography, to be able to invest in a new hospital, to be able to support the recruitment, to be able to answer calls from the community to contribute to affordable housing programs and those kinds of things we have to be able to generate a margin. And so financial and operational stability go hand in hand. Next steps with this whole thing is actually fleshing out, and we've got most of them fleshed out in terms of, what are the initiatives associated with these imperatives, and then, what are the tactics associated with those initiatives? And how are we going to measure success? How are we going to communicate that with everybody in plain language terms? And so you'll see that as the next step in our process. We want to put that by some of our other partners first, who were personally involved. And like our community advisory councils, Dave will be reviewing this with them starting in the coming weeks, to get feedback, because they participate in helping develop what these imperatives are. Let's make sure that our initiatives match what they had in mind when we came up with these imperatives those kinds of folks. So it's a bit of an iterative process, but we'll begin communicating this more widely in the coming weeks, you're actually my first external presentation of this information, beyond people who have signed up to be on our advisory councils or whatever the case may be. What questions do you have? Yes, ma'am. And could you tell me who you are, please? Because I don't know, everybody

NAAR Member: 25:39

participated in one of those 400 right? Thank you. It's great. And but I do have a question, yes, what is the cutbacks in Medicaid going to the hospitals? I understand, it's not going to be good.

Robert "Bo" Cofield: 25:54

It's not going to be good. So the question was, in case you didn't hear it, is, what? What does the big, beautiful bill and the cuts in Medicaid have for a rural healthcare delivery system like ours, we don't know yet entirely, partly because Medicaid is a relationship between the states and the federal government. Every state has a different relationship with the federal government, so the federal government has to decide how they're going to treat the states in terms of their interpretation of the 900 page bill, not all of which was related to Medicaid. So we've got to figure that out. The one thing that we do know is that none of the planned cuts take effect until 2027 so purposeful, they push that back beyond the midterms. That's pretty good strategy on their part, isn't it? So they push that beyond the midterms. So we'll see a little bit of it in 2026 but most of it in 2027 when you get out to the out years, it's as much as a $35 million hit per year to Northern Arizona healthcare. So all in about, I want to say $70 million and we would have loved to be communicating all along with the numbers were, but they literally changed. One morning, we got an update from our from our lobbyists that said it was a $4 million cut at 6pm later that day, we got 40 million. So it was all over the place. We're narrowing that down, and we think we've got a pretty good idea. So we're not entirely certain the plans for so one of the things that sort of when you hear, well, this number of people are going to lose their Medicaid coverage because of work requirements. Well, that was already a thing in Arizona. Arizona was going to do that anyways, because the state legislature passed that requirement. So we were already prepping for that. How we continue to enroll people, support enrolling people, and those sorts of things. So we're still developing our plans. So I can't answer your question. We've got big, broad numbers, but it's my job as a hospital administrator, healthcare administrator, to figure that out, and we will start working on figuring that out. We'll send our first community so this past week, two weeks ago, about ballpark, it was signed on July 4. We haven't even communicated to our board yet what we think the impacts are, because we're rapidly trying to figure out it's not positive. I don't know how negative it is. Yes,

Unknown: 27:57

that 35 million, what percentage of the total in combo.

Robert "Bo" Cofield: 28:03

So from a net operating revenue perspective, we're about 800 million on an annual basis, so that's a $35 million cut. So that is just under about 4% something along those lines.

NAAR Member: 28:18

So regardless of how much it is, let's talk about how that what that does to you, and how you get replaced.

Robert "Bo" Cofield: 28:26

And we don't know the answer to that question yet. So we've got to do two or three things. First of all, grow. The best solution to any income problem is to grow your income right before you start cutting costs. And so we need to figure out how we how we do that better. We've made some changes in some of our financial leadership in the organization. Back in February as because we're right, wrong or different, we didn't see plans about how we might move forward, regardless of big, beautiful Bill cuts were coming. And so we needed to be Who are hearing this in another forum in greater detail, please take that opportunity so that we can get the feedback on whether or not we're thinking correctly. I'm not everywhere in the community. Dave's not everywhere in the community. Steve's not everywhere in the community. Good news is our nurses are everywhere in the community if we pull them, and that's why we started with internal stuff. But we do want feedback from those of you who who helped make this economy go yes, yes, sir.

NAAR Member: 30:23

Yes, sir. Jim Schweikert, I understand that you did successfully bring on a neurosurgeon.

Robert "Bo" Cofield: 30:29

Yes, we did.

NAAR Member: 30:30

And if there are others in the pipeline that good news breaking news on, we'd love to hear. And I understand that Dave Chaney has been very much in hiring mode. You know, keep it coming until I tell you to stop. Kind of, yes, absolutely. Is that continuing?

Robert "Bo" Cofield: 30:45

That is continuing. So the Medical Group, So the Medical Group, they've told me that. He told me. So the medical group reports up to me, and he said, There's you need to know three things, and I won't tell you about the other two, but he said I made a commitment to the community that passed Paul would keep hiring until I told him to stop. Now, Bo, you and I get to make that decision. Together, but we're not even close, and I agree we are still not even close. So pass well has completely focused on recruitment, recruitment, recruitment. Same thing. We had a record number of employees last month of 132 in one month. Now that doesn't meet our need. We still have twice that many vacancies, if not three times that many vacancies. But we need to continue. We'll continue to focus.

Josh Maher: 31:27

Yes, sir?

NAAR Member: 31:28

When you're looking at a healthy retainment strategy, how long do doctors and nurses typically have stayed here at the hospital, and what is that healthy timeline for them to stick around the community?

Robert "Bo" Cofield: 31:41

So the ideal state is that they stay here for their entire career. I mean, that's the easy answer. I will tell you that I love it here. I want to retire from here. That means I got 12 years left. So you're stuck with me. Hopefully now you can run me out of town, if you'd like, certainly your prerogative. But we would like people to stay as long as they could what we have seen, and I'll just pick on one example. So radiation technologies, that's actually one area in the hospital where we continue to have a lot of travelers. It's typically a younger population, more mobile, not yet married, no kids, and it's often an associate's degree. So they're actually mathematically younger than people are coming out of college. And so, definitely more mobile. And so I would love to keep reassuring technologists from two years. That would be great. That would be absolutely wonderful, if we could do that. So it's very dependent upon One's, one's role in the organization. Sometimes I'd love to have it for two years for a neurosurgeon, we want Dr nickel to stay until he retires, which hopefully is like 15 years from now. So it's highly variable, depending upon Yes, sir,

NAAR Member: 33:18

I might be behind on the news. But I'm just curious if you're still considering options for alternate sites, or if you're or if you're very focused now on mitigating and modifying structures in the existing

Robert "Bo" Cofield: 33:31

So we are, we are focused on both. We are looking at and Steve has a charge to figure out what it might take in order to do it on the current location. I will tell you that is will involve stopping services for a period of time, and we need to ask the community if that's what they want, but we also need to be very specific in what those services are. So we're working on that plan. We're looking at alternate sites. I will tell you, Fort tot Hill is still in the mix. It said that is a hospital administrator's dream of a place to build a hospital Greenfield. There's not a lot of congestion to get there. It will be a much more efficient construction project, better utilizing the healthcare dollars of northern Arizona. That, being said, it may not be palatable to community. So we've got other sites that we're looking at as possible.

Unknown: 34:22

I know there's

NAAR Member: 34:22

I know there's been discussion of putting a school up here. Is that still in the works. If you guys doing any incentive programs, or discussing any incentive programs with the medical school,

Josh Maher: 34:32

We'll talk a little bit.

Robert "Bo" Cofield: 34:33

We'll let NAU talk about that we have, we have committed to NAU, that we are more than willing, and we wanted to be a partner in the development of all of their health related programs. We know that growing our growing our own, as it were, is the best way to do things at the same time there medical I don't know if anybody saw New York Times article about medical schools and the growth of medical schools over the course of the last five years and. United States in terms of the number of students that are being accepted, we don't have enough residency programs to support those medical students coming out of school, so that will probably be our primary contribution to helping with the health care program

Mark Colletti: 35:11

here in northern Arizona,

Unknown: 35:16

I think I heard you say that you know, might not have communicated well enough on the initiative and desire to have for tonight, you know. So

NAAR Member: 35:31

I assume we've learned from that.

Robert "Bo" Cofield: 35:32

Yes.

NAAR Member: 35:33

So having for titles, still on the table and still being, you know, looked at what kind of strategies is there? What kind of efforts? Is there more resources? Is there someone new that's like, Oh, guys, you didn't do this right? Let's do this way that can communicate that more effectively. Because, I mean, I don't know, personal standpoint, it seems to be exactly what he said a minute ago.

Robert "Bo" Cofield: 36:01

Yeah, so there are several new people who I don't know if I know how to do this, but I've built new hospitals and communities and in locations where communities didn't want them. Dave has also had that experience. Dave was literally, I think, brought in like, two months, three months before the vote. There's nothing he could fix at that point in time, as it were, part of what Jason did for us was say what communication worked, what didn't. Part of what noetic, who we got tasked to do some of those sessions that folks participated in, what works and what doesn't, in general about communication from Northern Arizona healthcare, and we're taking that all into consideration. What I'm not doing, or what we're not doing at this point in time, is developing a communication plan for each of the handful of sites that we're looking at. We will do that once we've narrowed it down a little bit further, when we know that what the pros and cons are, and we have the opportunity to float that a little bit so that we can get feedback from the community about this. Is why this location doesn't work. That might be one strategy for one site, and it might not be another strategy for another site. The one thing that we do know is we have to start with our employees and with our providers. If you don't have your employees and providers behind you and building them a new facility, you've done something wrong. yet, yes, ma'am.

NAAR Member: 37:47

Wasn't the kind of the whole pushback from the community was the lack of employee retention and bringing in a lot of traveling nurses. And didn't feel like Flagstaff, I've been here for 50 plus years, and Flagstaff hospital didn't feel like it was for us. It felt like it was about racking up dollars, racking up worker raises, and not for the community.

Robert "Bo" Cofield: 38:09

I wish it were. We lost $53 million the year before I got here.

NAAR Member: 38:09

No, I just think there was a

Robert "Bo" Cofield: 38:09

Yeah, so, so we didn't communicate. If we didn't communicate, if I say that to say we didn't communicate effectively that it's not about racking up dollars. It's about meeting the community's needs. One of the ways to meet the community's needs is have stability in your workforce. We weren't focused on stability and workforce. We were focused on, let's build a new hospital so that we can get a more stable workforce, rather than getting to basics like compensation, benefits, tuition reimbursement, those kinds of things. And that's what Dave brought to the table is, let's be more. Let's build a base before we start trying to do fancy things. Does that answer your question?

NAAR Member: 38:48

Yeah, let us think of the community. Yeah. No, you weren't working on public tension, just turning people in and out.

Robert "Bo" Cofield: 38:55

80% of my workforce in Columbia, South Carolina, was travelers during COVID. Yeah. Our highest was 40% here we were in pretty good spot compared to where I was in that organization.

NAAR Member: 39:08

I just wanted to say that I think most of us, at least a lot of people I know, the first person we asked about the whether they thought they needed the new hospital, was an employee, and I think that events, it was so right in doing that, because most of us got really bad feedback, absolutely, and I think that. And I also want to say that some stay with some, the communication is 200% better. But he, I feel like he's done a really good talk.

Robert "Bo" Cofield: 39:36

Yeah, I I do too. I'm glad I came to work for him. It's fun. I think I've probably overstayed my time here. I'll stick around after the meeting in case you have additional questions.

Unknown: 39:46

Okay,

Mark Colletti: 39:53

thank you. Thank you. Excellent to hear we're moving in the right direction. And Josh, you come. Up as Josh is the Associate Vice President of Community Relations with for NAU, and he also has Dr Julie Baldwin with

Unknown: 40:09

him. No, not today. Okay, Josh,

Mark Colletti: 40:12

Mike is yours.

NAAR Member: 40:16

They keep leaving you here every time you come see us.

Josh Maher: 40:18

I know, I know it's always supposed to tag team it with somebody, but I'm always here alone. You're an intimidating group, I guess. So. Dr Baldwin, as you pointed out, she's the vice president for NAU health, who unfortunately couldn't be here. And so this is really her presentation. It's really more in her wheelhouse, but I have a pretty broad understanding, so I have robust notes. So if I'm looking down, I'm trying to read her notes for the most part here. So so my apologies.

NAAR Member: 40:59

Hopefully she doesn't write with the doctor. Oh,

Josh Maher: 41:15

so that's coming up. I'll just sort of launch into it, but I'm here to give a an update on our College of Medicine and our pursuits. And first wanted to start with the need and what the data is showing us in terms of why we're pursuing this initiative. Talked a little bit about our existing strengths in the field and what we continue to pursue, even outside of the College of Medicine, and how that's informing our work. And then talk a little bit about the vision of the institution and how the college of medicine is aligned with both the need and our our overall vision. And then we'll talk a little a little bit about where we are in terms of the timeline. Give it to you in advance that we don't have a lot of firm answers, just given a lot of external factors that are happening right now, this is she's on.

Unknown: 42:26

I'm sure it's

Josh Maher: 42:38

gone. Yeah, we're good. All right, so let's start with the Arizona Board of Regents in 2022 did a healthcare gap analysis, and so this is really informs us as to why this initiative is so vital for our region. It paints a pretty clear picture of the pressing need across our state and NAU as a state institution that really focuses on Northern Arizona, is obviously very, very important to us. As you can see, Arizona's worker to health, work care worker to population ratio is significantly below the national average in almost every category isn't just a statistic, but it translate to real challenges in our communities, crucially, rural county counties, like many here in northern Arizona, face even greater struggles in recruiting and retaining health care workers. There's just a lot of barriers here. It's a great direct impact on access to care for our neighbors. We also have fewer beds per capita, and our public health funding ranks among the lowest nationally, and this creates a very strained system, as you probably are aware of. The bottom line is that nearly 3 million Arizonans have limited access to primary care, and over a third of our hospitals are facing critical staff shortages, and this is the landscape that we're working to change. So to put a finer point on that, unless we take some pretty decisive action, the growth in healthcare professions over the next decade is projected to decade is projected to slow, exacerbating these shortages, and this slide shows projected number of professionals needed by 2030 to fill our critical gaps. And you can just look at the numbers. We have over 14,000 registered nurses, more than 3600 physicians, and over 2400 behavioral health workers. And these aren't just abstract figures. These are these are the healthcare providers our communities will desperately need, and really less than six years right around the corner, so the shortage impacts everything from emergency room. Wait times to availability to family doctors, and it directly affects the quality of life and economic vitality of our communities. So to get into a little bit about the work that we're already doing and the work that helps inform our efforts toward a medical school at NAU while the challenge is significant, we're not starting from scratch. We have a robust foundation in healthcare education. I think that sometimes we don't do a great job of telling the story, and we're already making a substantial impact on Arizona's healthcare workforce. Our College of Nursing is a prime example, graduating an average of 180 nurses per year with an impressive 96% pass rate on the national licensure exam. And these graduates are already serving our hospitals and our clinics, so they're day one ready. The College of Health and Human Services services has awarded nearly 6000 professional degrees in the last five years alone. Our doctor of physical therapy and our occupational therapy programs boast near perfect graduation rates. So those we use a cohort model, and so there's a lot it's a very supportive environment. Making sure that people are held accountable, and we do a great job of moving people through the education to workforce pipeline. Our physician Physician Assistant Studies Program has graduated over 441, pa since 2014, with 58 just this last year alone. And many of those professionals choose to practice right here in Arizona and right here in northern Arizona, often in underserved areas. These existing programs demonstrate any is proven capacity to educate and graduate high quality healthcare professionals who are ready to meet the state's needs. Beyond that, we have several research centers and institutes. We bring significant research strengths to the table, particularly in the areas relevant to Northern Arizona's unique health challenges. We have the Center for Community Health and engaged research. We love long acronyms. We're building and transforming health outcomes with a focus on rural health, underserved populations and behavioral health, all which are critical areas for our region. Our pathogen and microbiome Institute, which we call PMI, is a multidisciplinary unit conducting cutting edge research on infectious disease, including relevant to including those relevant to public health and community well being. And we also have southwest Health Equity Research collaborative, another long acronym, and a nationally recognized center support research on health disparities among diverse populations in the health and in the American Southwest, and this directly aligns with our commitment to equitable health care. These centers provide a strong academic and research background backbone attracting talent and fostering innovation that will be invaluable to our College of Medicine now in terms of our vision. And we asked the question, how does a College of Medicine at NAU fit into the broader picture? And really, it's about bringing the vision to life in a in a very powerful new way. First, will be an engine of opportunity, and these are all elements that are pulled directly from our strategic plan. By addressing primary care workforce needs and fostering economic mobility, will launch graduates into careers of consequence, serving our communities and propelling healthier, more prosperous futures. Second, it'll be a driver of social impact. This college will fuel the eradication of health disparities, bringing the idea of truly equitable society closer to within reach for all Arizonans, and especially those in underserved areas. And finally, it'll be a vehicle of economic mobility, by creating a one of a kind model for medical education, we'll strengthen the entire healthcare education ecosystem in Arizona and beyond and create new jobs and economic activity right here in northern Arizona. And the vision is deeply aligned within a use mission to serve Arizona and beyond, and it builds directly on our existing strengths in health, education and research. The slide further articulates how the College of Medicine's vision is uniquely tailored to Northern Arizona's needs and builds on our institutional strengths our community centered approach is. Paramount. We want to make sure that it this college is in and of Northern Arizona foundation College must be strong partnerships, which we've already begun to establish, and many of those are long standing partnerships that we've had in many different ways. We're also looking to expand our partnerships with indigenous and under underrepresented communities, and will be rooted in the needs of the people it serves, ensuring relevance and impact. And the curriculum we're designing, we designed specifically for our communities, emphasizing in integrated and team based care, a strong rural and tribal focus and trauma informed care. It's not a generic medical school, it's one that's built for our region. Now we're also committed to innovative and accessible education. This means exploring new teaching methods that leverage technology to deliver cost effective education and effectively serve rural communities. We're also looking at the potential for accelerated models down the line, and critically, we aim for a sustainable and equitable funding model, and that's the important piece. You're not going to pursue something that we ultimately can't fund, that's going to falter within a couple of years. So we want to make sure that we have the financial backing for it, and we and hopefully, the model that we're pursuing could lead to a process where we have low to zero student debt. So many people leave medical school just settled with hundreds, hundreds of 1000s of dollars of student loan debt, and that's not acceptable for the model where we're pursuing. It's about removing barriers and ensuring that talented students from all backgrounds can pursue a medical career and serve our state. Now to get into a little bit about where we are in the process, can anybody guess where I've outlined sort of three broad phases. Can anybody guess as to where we might be having launched this initiative just what about a year and a half ago? We're all the way over. I started somebody say first, that's exactly where we are. So question is, how do we bring this vision to reality? Developing a college medicine is a multi year and highly regulated process. Side outlines the general phases that are involved, and talking about extensive planning, curriculum development, faculty recruitment, facility development and a very rigorous accreditation process. It's not a marathon, but it's a it's not a it's a marathon, it's not a sprint. Let's get that out of the way that requires very careful, deliberate steps to ensure we build a high quality and sustainable institution, and we're currently in the as I identified, we're currently in the foundation planning and strategic approvals phase. This is where we're going to doing a deep dive into the overall feasibility, financial modeling and securing all of the necessary initial authorizations. Now we know that we've already established that there's a need. Now it's just a matter of putting dollars behind it, or getting the state to put dollars behind and we all know what's going on safe. Needs and opportunities of Northern Arizona. So with that, thank you for your time and attention today. Takeaway is that the development the NAU College of Medicine is a critical and potentially transformative initiative for our region, and that's obvious. We know that this will be a long process just gotten started, there'll likely be some stops and starts along the way. College of Medicine will build on any use existing strengths in this field, and will continue to be informed by our relationships within the community and the unique characteristics of northern Arizona. So with that, does anybody have any questions?

NAAR Member: 55:43

You say long? How long a decade is that?

Josh Maher: 55:48

I thought that you might try to pin me down my timeline? So we are very, very early in the process. And give you an idea of sort of how long I've seen these processes happen my early career. I was part of an institution that we had a lot had launched a work was had announced that they were going to launch a college of medicine that was in California, where the regulatory environment is a little different, of course, but they, announced that they were going to pursue a college medicine the year before I arrived. They got it off the ground year after I left, eight years later. So it can be about a nine to 10 year process, yeah, so but, and a big hurdle to that, of course, it is was there and is is here, is funding, making sure that all of the, all the dollars that behind it. You know, the state acknowledges the biggest need. The legislature acknowledges that there's a need, a board acknowledges that there's a need, just a matter of making sure that they're putting the dollars to that to that effort.

Unknown: 57:10

Yes,

NAAR Member: 57:11

I'm married to an emergency physician needs CO. Is there any consideration that would be an osteopathic school?

Josh Maher: 57:17

You know, the initial conversation that's, that's where, that's where it's likely headed. I know that. You know, we want to make sure that we are distinct. You probably heard that. You know, with U of A already has their college of medicine. ASU is ahead of us because it's ASU and they're they're pursuing the the nd route, and so we want to make sure that we're distinct and not overlapping or competing in any way. So likely a do, yes,

NAAR Member: 57:54

just wondering when President Cruz, Mayor Cruz, made his speech at beginning of 2024, some years. So last year's beginning of the State of the Union address. Yeah, he talked about cuts, a lot of cuts. So we know and that our faculty at NAU are still having a lot of difficulties in being able to purchase a home here. And so retention across the board, across every school that we have is difficult for them to maintain, and we lose a lot of faculty as a resident of five staff. Now, since you were here last, have you been able to buy a home yet?

Josh Maher: 58:39

I have not. I mean, I think the problem has only become worse.

NAAR Member: 58:42

So we're looking at a medical school, which is going to cost us a lot of money, but we still have faculty at the university that cannot afford to live,

Unknown: 58:52

to live,

Josh Maher: 58:54

yeah. I mean, and we're, we're engaged with the city on a lot of different fronts, that the resources they're putting towards toward housing, that we're trying to inform those and making sure that they're aware of the need. You know, there's only so many level levers that we can pull as an institution. You know, we you know, ongoing funding uncertainty. We continue trying to, trying to make sure that our staff and faculty are fairly compensated, although you know that's it still is a massive barrier, just given the accelerate accelerating, ever accelerating cost of of housing in our region,

NAAR Member: 59:44

And is Kinsey still on time to open a new school and NAU will take over that property.

Josh Maher: 59:52

So FUSD board has approved that that transfer, and so once. we will take control of the current Kinsey elementary school site.

NAAR Member: 1:00:10

Will that be developed into something

Josh Maher: 1:00:13

our current plans point towards a early child development center to make sure that you know also you pointed you talked about housing. Another critical issue in the region is access to childcare, and so we're looking to try to meet those needs, initially, for our employees and students that that face some really acute challenges in that arena, students in particular. So So that's the idea. Thank you. Yep, yes sir.

NAAR Member: 1:00:46

Where's the college? As far as like, putting this Medical College in? Is it going to be something built on cannabis? What does IT infrastructure look like?

Josh Maher: 1:00:53

We haven't gotten there just yet. We will likely utilize our within the boundaries of our current counts, current campus, primarily, you know, also, you know, eventually, you know, develop stronger partnerships with NAH in some way.

NAAR Member: 1:01:11

I mean, just common sense. We're all sitting here talking about this. We need a new hospital. We're trying to get this call. I mean, yeah, make sense to build a new hospital. And then you guys work the partnership to, yeah, the existing one we have,

Josh Maher: 1:01:24

We do envision a stronger, a stronger relationship with NAH. Any other questions?

NAAR Member: 1:01:32

With all the budget cuts that are going on with a scholarship, a lot of medical student scholarships. So how are you guys proposing opening this medical school when there's a lot of cuts in there, it's limiting people's access to even be able to attend medical school.

Josh Maher: 1:01:48

Yeah. So, so one of the things that we're looking at is, and for for those of you who might not know, so in the current in the rescission package, there was a significant limitation on the amount that folks can borrow for advanced degrees. They need to cap it at 200,000 or something like that. We're looking at models from this that take that rather than students going out at the student loan market and be saddled with years and years and years of debt and acknowledging that that's a barrier to a lot of students, just the concept of of taking on that much debt. We're looking at models that, that where students don't, aren't saddled with that, that that kind of burden, although we know, you know, in a lot of different fields, it's going to have some real We do know we have a lot of unanswered questions in terms of, like, what the federal government is doing and what the fallout ultimately will be, but that's something that we keep in the back of our minds for sure, yes,

NAAR Member: 1:03:09

where's the lumberjack?

Josh Maher: 1:03:10

So the lumberjack is currently in storage. that Louie had to take on, and it's the lumberjacket and grannies right, probably gone by and seen that's gone, and our man, a friend, Jake bacon, to all sit down Dramatic eulogy. But we have Louie, isn't he? Safe and sound and storage is going to require about $15,000 worth of so we're going to look to sort of raise some of that by with some of our pipe encounters the

NAAR Member: 1:03:54

Go Fund Me,

Josh Maher: 1:03:55

Yeah? Well, yeah, we have folks that are that are on top of it. The city is also approached us about using that Louie as part of the route 66 celebration. So we hope to partner with the city on that front.

NAAR Member: 1:04:08

Yeah, sticking on the topic of Louie. Has it? NAU ever up? Wanted to update the way Louie looks. Okay, so Louie has looked the exact I'm born and raised here, so Louie has looked the exact same for the past, however long, Louie has been a mascot for Mayu. But have you ever thought about maybe getting the community involved on maybe revamping Louie? You know, Keep Louie, Louie,

Josh Maher: 1:04:39

I think we're although we've had this version of Louis for a little while, I think this is our I don't know, but maybe some, maybe some, sometimes soon you have any input, you know,

NAAR Member: 1:04:56

Just standing out there by himself, Louis. So.

Unknown: 1:05:00

Be

Josh Maher: 1:05:02

U of A with wasn't Wilbur?

Unknown: 1:05:05

Wilma, yeah, you know,

Josh Maher: 1:05:08

but maybe, maybe someday there's an opportunity. Louisa, we don't

Unknown: 1:05:15

have a mascot.

Josh Maher: 1:05:19

I love this group because it's always questions that are just come out of awareness. But I'm, you know, in my role, I sort of have to have a broad understanding about a lot of different stuff, and so it's always fun. And yes,

NAAR Member: 1:05:32

going back to what you were really talking Okay, when you say a model that where they will have to go out and borrow what, how does that look? I mean, where, who's going to fund their education?

Josh Maher: 1:05:44

So we've engaged already in the planning phase the Narva Institute, who's put, put forward, I towards this effort. And so a lot of it's going to be coming from philanthropic, philanthropic dollars, combination of of state dollars, federal dollars, if we can get them, but a lot of that's going to be funded through through private donors. Yeah. Any other questions? All right, I appreciate your time. I'll be staying standing around a little bit if anybody was afraid to ask any

Mark Colletti: 1:06:20

I thank you very much both of your time today and informing us what's going on, community. Really appreciate after I think that concludes today, couple things, please, even the agents take your questionnaire out. It's five questions. Help us make decisions at the association, we really like it, and there's also a great deal of wildfire action guides at the NAR office for your for you and your clients to educate your clients. Thank God we have rain, but still need to be educated. Thank you all for coming. Appreciate you. And even mortgage and Northern Arizona leaf services. Thank you again for sponsoring us. Have an excellent day and go make deals. Good.