Submitted by Cherokee Indian Hospital Authority
The August meeting of the Cherokee Indian Hospital Authority (CIHA) Governing Board highlighted progress in addressing workforce shortages at both CIHA and at Tsali Care Center while brainstorming interventions to improve ongoing challenges. CIHA’s Executive Leadership provided updates on how individual departments are growing the workforce, expanding services, strengthening cybersecurity, and stewarding resources to serve today’s patients and the next generation.
Interim Director of Human Resources Tina Vaitkus opened the monthly meeting with introductions of new employees and a snapshot of workforce demographics, including department-level representation of enrolled EBCI (Eastern Band of Cherokee Indians) members. Environmental Services is approaching 80 percent EBCI representation, while some credentialed and medical roles remain underrepresented—an area of active focus. Recruitment efforts include school and community partnerships led by Tara Reed-Cooper, CIHA’s Career Development Coordinator, internal career ladders and certification opportunities such as the nurse aide program which just graduated more than a dozen individuals, and benchmarking against local demographics to guide outreach.
Interim HR Director Tina Vaitkus provides board members with demographic data for current employment levels. (CIHA photo)
CIHA’s Executive Director of Engineering Damon Lambert updated board members on construction progress at the new Cherokee County Clinic site located in marble, which reached the visible milestone with the exterior being completed. Damon also provided updates to the Pharmacy Expansion project, which remains on track. Portions of the construction project that have caused the drive-thru to be closed two days a week are nearly complete and operations will continue as normal in the next few weeks.
EBCI Tribal Option Executive Director Karen Kennedy informed the board that the Tribal Option team has been working through issues within the state data-system issues that misidentified roughly 1,000–1,500 members. The TO team have been assessing the data and making adjustments where needed to ensure individuals are properly attributed and supported.
Executive Director of Operations Mary Beth Dorgan addressed accessibility challenges in CIHA’s Eye Clinic due to being short-staffed by one optometrist. The challenges will hopefully resolve in the coming weeks, as interviews are currently underway to fill the vacant position.
After hearing monthly reports from CIHA’s Executive Leadership, Governing Board members provided reports from the various subcommittees that they serve on for CIHA. Each member of CIHA’s Governing Board is assigned to a sub-committee based on their interests and expertise. The sub-committees meet monthly prior to the monthly Governing Board meeting.
Sonya Wachacha, who serves at the PHHS board Representative on CIHA’s Governing Board is the Chair of the Long Term Care Committee provides the routine monthly report to the Governing Board, however due to scheduling conflicts, the sub-committee was unable to meet prior to the Governing Board meeting. In place of a report from the sub-committee, Michelle deVille-Tenhengel, Administrator at Tsali Care Center provided an update on the results from the recent CMS annual survey and complaint investigations at Tsali Care Center. According to Michelle, three complaints were investigated and all were deemed unsubstantiated by the state. Surveyors found no deficiencies in dietary, kitchen, housekeeping, medical records, rehab, or activities. Michelle reported that the survey did however show minor, isolated findings which included a single medication error and a few dignity-related items, such as assistance with facial hair or socks being inside out. Michelle also noted that overall, the primary improvement area based on the survey can be solved in improving documentation. While quality & performance improvement work has been ongoing at Tsali Care Center, CMS expects formal Quality Assurance and Performance Improvement (QAPI) project documentation. CIHA is updating its quality policy, formalizing QAPI charters and measures, and expanding routine audits. A cross-functional committee meets weekly and tracks progress on a red-yellow-green dashboard.
Marcia Hollifield, who serves on CIHA’s Governing Board as a Community Representative from the Snowbird Community serves as the Chair of CIHA’s Patient Family Advisory Council. Marcia reported to the board that PFAC met on Aug. 12 and advanced a proposal – which has now been approved by Governance – to extend hospice eligibility on the CIHA Medical Inpatient Unit to certain non-enrolled immediate family members. Extended eligibility to these members of the community will allow families of loved ones who have resided in and serves the EBCI with end-of-life care in their final days. Marcia also reported that members of CIHA’s PFAC contributed 34.5 volunteer hours in July, many of which were spent reporting to their respective community clubs regarding news and information for CIHA. The monthly PFAC report to Governing Board also included details of ongoing work of the board such as accessibility challenges and possible solutions in scheduling, expanding security at Tsali Care, and recent mandated changes to the pharmacy formulary that caused changes to medication for a handful of patients.
Due to a current vacancy on CIHA’s Governing Board for the Physician Board Representative, the Quality sub-committee is being Chaired by Dr. Richard Bunio, who is a member of the Governing Board based on his role at CIHA as the Executive Director of Clinical Services. Dr. Bunio presented the Governing Board with recommendations for approval for new medical staff appointments. Dr. Benjamin Ginny was approved as a hospitalist/emergency physician, Jennifer Peterson was approved as a primary care nurse practitioner, and Rachel Pitcher was approved to join CIHA as a certified nurse midwife. Dr. Bunio’s Quality Committee report to the board also included the reappointments of 12 existing staff across dental, radiology, emergency, orthopedics, and behavioral health. Dr. Bunio also reported that three providers transitioned off provisional status after successful reviews.
Although CIHA budgeted conservatively entering the next fiscal year due to uncertainty on the federal level and potential impacts of cuts to Medicaid expansion, Adele reported that due to the fiscal responsibility of CIHA’s Finance Department, the board was able to approve absorbing up to $5.5 million in anticipated operating losses for Tsali Care Center to maintain stability for residents and families for the second year in a row. Prior to last year, the Tribe covered the operating loss for Tsali Care Center as part of the joint operations agreement for the long-term care facility following CIHA assuming operations. However, due to CIHA’s strong financial position and budget constraints with the Tribal budget, CIHA Leadership made adjustments to absorb the costs internally.
Barbara “Sunshine” Parker, who serves as the Attorney representative on CIHA’s Governing Board, provided the monthly report from the Governance sub-committee, which she Chairs. Sunshine informed the board that the focus of this month’s Governance Committee was centered around an update on federal policy. CIHA is currently evaluating participation in a national coalition monitoring administrative changes to 105(l) leases. The Tribe currently receives more than $17 million annually in 105(l) leases, underscoring the importance of staying engaged in a political climate that changes frequently
From workforce pipelines to clinic construction, from safer systems to shorter wait times, the work is moving forward. CIHA remains focused on access, quality, and stewardship – delivering care that reflects the values and priorities of the Eastern Band of Cherokee Indians.
