Mikaela Kienitz, CEO, Boone County Hospital, October 2, 2026

I'm visiting with Makayla Keena. She is the CEO of the Boone County Hospital and Makayla thanks for joining us on our program. Thank you, Jim. Had the board meeting and again the last what well let me see in September it I would say it out say it out there because we know it's happened but the last one for Troy Thompson. Yeah he has decided he's gonna step away after several years on the board and chair several years as chair. Yeah Troy has served the board for probably 12 or 13 years I think and he he was the board chair for over 10 years of that time and so you know he's been a really influential important part of our board for all of that time and so he led the CEO search and so I've been very close with him and I am excited for his next step but also sad to see him leaving the board. Well he's moving on and again the recommendation has to invite Jamie Youngs to fill his place. Yeah Jamie has been a really strong member of our foundation board and so he's got a lot of knowledge and economic development and obviously financial background and so we feel like he'll be a really good addition to our board and he's very supportive of the hospital. Well that means we got to find another member for the foundation board too. Yeah I think that I know I think that Rachel did have a somebody had reached out just prior to Jamie considering the open board seat she had someone reach out to join the foundation board so I think that that's going to work out well. Work out okay. Well let's talk a little bit about this meeting I think the big big thing I kept telling people out of the meeting at the last meeting here in September was yeah Brian Green and again a accountant with Ivy Bailey audit report and he kind of again what he does is kind of a summary doesn't get into a lot of the a lot of the weeds and things but it is basically he had really was very complimentary to the position you guys are in. He was very complimentary he had a lot of great things to say and we you know we had a really good year like we've talked about our best year ever and so I think one thing kind of that I'm taking away from the audit is that you know they didn't have to make any adjustments to the audit. Our team here and the team at Ivy Bailey worked really hard to get you know accurate information and we do things all year long to make sure that we're doing a good job and so it was an audit that did not require any adjustments and Brian shared that like about 15% of the hospitals that they do audits on don't require any adjustments and so that was a big win for our finance team here Chris and Sarah they worked so hard on that so I was really proud of them and you know like we talked about Brian said we had a really great year he had really good things to say and and so that was exciting to see it's exciting to see the growth and the improvement in the hospital's position. Yeah he did I know he's he mentioned your revenue was up eight million some pretty close to that and and he did point out again yes folks cost of operating about two-thirds of that is people cost. Yeah about two thirds of it is people and I know I don't know that he mentioned a number this year but I know he did last year but this year we know that the it cost about a hundred and around a hundred and seventy thousand dollars a day to run the hospital and so you know much of that is people and and our people are our biggest asset and so you know we just continue to work on it reinvesting in them and and making it a great place to work and and trying to be competitive workplace so you know it's just it was really nice to hear him say that the hospital's doing so great. I know yeah you mentioned that hundred and seventy thousand it was it was less than that last year so it was surprisingly folks the cost of operations just have not gone down. No and you know we continue to try to bring in new equipment and and improve our facilities and you know like I said we've invested a lot in our staff. Steph Bowers was also at the meeting presenting for HR and and she did share that you know some of our staff we're giving either between a five and seven percent raise this year we did that also last year and so when you think about that and you know on a big scale we have four hundred and twenty employees that's a that's a pretty big reinvestment into our team. And she did mention I know on her part just getting away from the audit for a little bit but she did talk about because they bored to specifically asked about retention efforts and yes you do you do work on that because you like them coming back and then she talked about the recognition that's coming up how many are in that what five to ten year group. So again you have staff that's been here for several years. Yeah and the five and ten year group is pretty large I think she said there's around sixty getting there five ten fifteen twenty twenty five and then thirty plus but which is one of our largest groups I think but I think one thing that one statistic that you see out there is that if you if staff leave it's generally within the first five years and so we work really hard to get them to stay here to retain our staff to have them enjoy working here and get fulfillment out of their career so I'm excited that we've had so many people stay you know for this long and it's a big milestone for the hospital. Well one thing back to the audit report and I know because he does have access or he did have access to other critical access hospitals so he was kind of comparing you to I think primarily to Harlan and you know looking at some you know size and area location that sort of thing and very comparable and in fact much better off than quite a few of the critical access hospitals in the state. Yeah he did say that he did he did use Harlan kind of throughout the audit as a as a comparison and it looks like and you know some things are really really comparable and some things were exceeding by a long ways and so it's it's good to see that and we want to make sure that we are staying in those in that spot and not you know and not kind of slipping down or anything like that and so it's kind of been interesting to look at the net position you know over the years and that's one of the things that he presented and so when you look at you know where we were five six years ago compared to where we are today and there's a lot of things that impact that right yeah directed payment program with the IPRs adjustment that we make he talked a bit about that so there's just a lot of things that impact it but a lot of the things that we're also seeing is increased growth and so and an increase in our OB program has affected the Medicaid directed payment program and how much we get from that and so it is really fun to look at kind of the graph that he presents and see how how much improvement we have seen in the last five years. So people wonder because they do point out what other positions are with other hospitals yes Boone does get used as examples in other hospital audits so I mean it's all part of the information that's out there. One thing he did talk about and he did point out that there are a few critical access hospitals similar to Boone and our age of plant is getting up there. Yeah our age of plant is you know it's it's it is high and so one of the things that you know we've been looking at a lot is our facilities and our plant and what we're going to do in the future and so we're still you know as we've talked about many times Jim the board is still looking at this and talking about this constantly and trying to figure out exactly what we want to do about that in the coming years. I know that yeah it doesn't happen overnight. One thing people ask me is there's it's a long it's a process. There's a lot to go through you know you get ideas and stuff and then basically yes we got to go back to the state and say here's what we're looking at doing. Yeah there's a lot to consider there's a lot from a financial perspective there's a lot from a service perspective where what do we see ourselves what services do we see ourselves providing in the next you know 20 30 years how many staff will we have how many patients will we be able to serve there's just so many things that we look at when we have the discussions about our facility. Well let's talk a little bit about some of the other things because I know you had your go basically your dashboard. Oh the organizational goal. Yeah Dan and she keeps tabs on stuff for you and had some you know we're relatively early into the new fiscal year but pretty good start in several areas. Yeah there's a really good start that's occurred in a few of the areas here especially like our quality stuff that we're looking at we've seen some growth there in our community events but kind of overall it's been a little bit of a slow start from a volume perspective to the year which I think is typical it's typical time for things to be a little bit slower we'll be very soon here getting into cold and flu season and we'll really start to see some of that pickup and so I'm not really concerned about those volumes at this at this minute quite yet but one of the things that Steph did also present on was our people goal is to achieve a top workplace designation and so the board set that as part of our strategic plan a couple of years ago and so we've been taking that survey so the survey closed on Friday it was open for two weeks we needed 35% of our staff to participate in it and I think I think she said we were like in the 50s or 60s and so that's really exciting and I'm eager to see the results of that and find out if we were able to achieve a top workplace designation that's the top workplaces through the Des Moines register so you kind of see that come out and so a lot of hospitals do achieve a top workplace and it's a really again it's a really nice tool to use for attracting talent to our organization and in retaining staff and for staff willing to take that survey I mean that's the big thing too like you said you got to have over a third have to do it and you guys were well over half that's that's a pretty good response yeah absolutely we were excited about that so I'm eager to see what comes up that so that's one of the big things we've been working on this fall and you know we've spent a couple of years with our people goal if you think about the organizational goals dashboard over the last couple of years we've continued to work on wages and benefits and getting folks through book club and doing things to make a great culture and so now it feels like it's time to survey and and see the results of that at the same time we do have ongoing changes we got to keep working our way through again orthopedic is one area in particular still working on that family practice people still I mean we're still adding to our well we have not let up on recruiting let's put it that way yeah he's done an amazing job with recruiting she worked so hard at that and just as a really nice job so I think Dr. Stevenson is going to be moving to the emergency room and still doing some OB coverage for us and she's going to move in the beginning of the new calendar year so in January but in December we have two new PA starting in one in our South Clinic and one in our North Clinic and then we've also been able to recruit a new family practice doc with who will also do OB she's in the bread lawns residency program right now and so she will start not until 2028 but that's you know the recruiting it takes a while and so excited for that and then we've had another candidate on site last week to consider our position as well and I think that she also is very interested in she's also family practice with OB and C section and so we just continue to recruit we're also recruiting for our emergency department and we are continuing to recruit other family practice doc so we know that patients want to get in and we want to make sure that we can get them in as soon as they want to get in and have that access to care be improved and so we're continuing to recruit but you know there's a shortage out there and it has been challenging one of the others of course is in that area of orthopedics and I know that was one of those key areas where you really enjoyed having capital come in but they were they're seeing a change in their operation so once again not going to be able to continue that but looking for our own and there is some interest yeah yep there is we're starting to work on a a search for our own orthopedic surgeon and I think that's going to be really good for the hospital having that specialty available more regularly and being able to do surgeries more regularly it will help with things that are more emergent and things like that and so I think having our own surgeon is going to be really good yeah Dr. Zayed is leaving capital and so that's causing capital to sort of shift where their outreach is going in so they won't be coming here any longer although in the gap while we do continue to do our our search for our own surgeon I think that we are working with capital to see if Kirby can stay here and help take care of our patients so we don't want there to be a gap for anyone so we're working hard to to cover that time smooth smooth that transition and again those are it's not the not we're not the only hospital going through the issues of trying to maintain that kind of service yeah but it's happening kind of across the board and and it's not just specialists it's family practice doctors everybody kind of like we were talking about but you know we just keep plugging away at it and and thankfully we have someone here who's great at recruiting and and works really hard at it and so that's been good for for our hospital well we keep that part and we just keep working ahead let's talk a little bit about some of the guys have been busy well let's see Puffer Billy parade was warm actually did not turn out too bad that day no it didn't it turned out pretty decent had a lot of people in the parade from the hospital and again you did that went down to matter for that was a little wetter they postponed that one a little bit yeah so we've got those but other things coming up and of course on the foundation side the fundraiser for harvest the harvest festival people can still get tickets they're still out there yep they're still available harvest festivals coming up on November 13th and it's going to be an around the world theme and I think it's going to be a little sort of different than what we've experienced in the past and I think that's going to be good it's always we're always thinking of ways to change up that event and make it fun and interactive so Rachel's done and there's a team of folks at work on the harvest festival from the foundation and the foundation board and from our community and so and actually on that committee this year they included two staff members and I think that's going to be really great Rachel's been going around to all the department meetings and inviting staff to come to the harvest festival and I think we've gotten quite a few staff tickets sold so that's going to be really nice to see have community members engaging with our staff members and and really understanding why this is so important and then from a foundation front she's also been working pretty hard on Project Be the Light and she's done a you know we had a really successful baseball event this summer for raising funds she's done a swimming event and I believe this week was last week we did a volleyball event so it's really starting to kind of take off and and and using the sports as a way to to get to the folks that you know can help contribute and and help get that word out there has been has been really good and I know that uh what last week our end of the month well as we get into the end of this month uh senior life solutions open house and and again they've been out doing a lot of making the public more aware of the service that's there yeah they've been doing a really good job of getting out and and talking about it um you know I just was talking to Brittany Guest last week she's the director and SLS and she was mentioning that their second track is also really full which just opened not that long ago and so uh that's that's exciting and so there's a one location in the United States that has three tracks and we're really starting to wonder if we will have the need to open a third track and so we're starting to look at that and talk about that and I think that's really good it really talks about the need for that service and and how you know how folks are are utilizing the services here at boom county and that they don't have SLS and story county so that's helping our volumes as well and it does fit into uh the the survey that was done the community survey community needs again mental health services were that was up there yeah absolutely and and you know we we've seen that we've seen that uh need for that service and the growth there and um yeah so the the community health needs assessment is what you're referring to and and that was one of the top things that was needed was mental health and so you know on the other side of that we have bryle's in our um outpatient clinics and he's been extremely busy as well and so it's good that people can get these services locally and not have to travel well I know that there's a a lot of other things that continue to go on but as we get ready to head towards holiday time I'm going to remind folks October that's going to be the last like regular regular meeting for you because when we hit the end of the year uh nobody likes to meet on Thanksgiving I just don't understand I know right yeah no we'll combine meetings I think we're either looking at December 3rd or December 10th we're going to check with the board to see which date will work the best but we will end up combining the November and the December meeting so we'll have our October regular meeting on the 22nd and then we'll have our combined meeting in early December and uh just going to remind folks that uh I know that public health now is doing the blood drives with life's or blood centers so they should make sure they get signed up for those I think you're going to have one at the hospital here uh coming up next month so yeah yeah that sounds great that'll be another one and I know there's oh there's a lot of other things too you guys will be doing and uh yeah I get and Rachel's got all kinds of things she'll be working on after the harvest festival she does and and Lydia's doing a ton of things for public health and so um you know kind of one of the big things that's happening are going to be happening this time of year as the flu shots and COVID vaccines and all the stuff is is starting to get moving so we're into that time of the year yeah we're getting very close to that season which seems kind of crazy because it feels like this year just started and we're about to end that's because it hasn't quit raining this is true we keep plugging away at it too otherwise uh uh facility wise everything else is running I saw the ambulances unfortunately they go a lot yeah so uh but that's why they're there to transport a lot of patients yeah it's been busy I mean everything has been really busy and any ambulance calls are are not immune from that and so they've been they've been busy lately and and that's good um and you know we're excited that we're able to provide that service to our community and uh every once in a while I look to see how walk-in clinic numbers are doing and yeah you get you have a high traffic you still have a lot of traffic so yeah and I you know I anticipate those numbers picking up here and like I said in the cold and flu season but it has been it has been busy and ROB continues to be busy and grow and it's just inpatient has been busy it's it's it's a good thing that a good problem to have for the organization you know I I don't it's there's kind of a double edged word with that people are sick obviously and needing services if if your numbers are high so I think the the good thing here is that people are always going to be sick and they're choosing to come here for their services and so that's what we really are after I was going to say yes a lot of times when they have to go to the hospital it is not their best day right and that's why staffing and having staff that uh make them feel better is is a big part of it too it's really important it is important to you know pay attention to our staff and and reinvest in those folks and make sure like I said that their cup gets filled when they come to work so that because they are pouring into our patients and they are the ones that make a huge difference in that experience and so it it is really important that you know we do a good job with them okay lecuna CEO of the boon county hospital our guest on our program our health talk program thanks for joining us and I'll talk to you again next time thanks for having me gem