First of a series Picture this: a town so small, it has no stoplight. And it's in the least-populated county in the state. Fourteen hundred people live...

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First of a series

Picture this: a town so small, it has no stoplight. And it’s in the least-populated county in the state.

Fourteen hundred people live here in 60 neat blocks of fine Victorian mansions, mobile homes, 1950 ranchettes and quaint bungalows plus two restaurants, one drug store, a welder, a library, three antique shops, one law office, a couple of tiny grocery stores and a dilapidated old (circa 1948) hospital/nursing home combination that’s well on its way to creating a revolution. Welcome to Garfield County Public Hospital in Pomeroy, Wash. When I told friends I was going there, they asked, “Where?” It’s in the far corner of the state where Washington, Oregon and Idaho meet, nestled in the rolling hills of the beautiful Palouse. The main industry is farming. Like most rural areas, younger people flee for jobs and schooling elsewhere, so the population is mainly older, a trend that’s expected to continue.

Typical of rural hospitals, Garfield County’s is small — four beds for acute (hospital) patients, 20 beds for the nursing home and 21 “swing” beds for long- or short-term stays. Because there are no other medical facilities available, the hospital’s existence is vital to the well-being of the entire county.

But in the 1990s, the hospital almost closed. Due to Medicare reimbursement changes, it was a quarter-million dollars in debt, with no revenue coming in, and on the brink of financial collapse. The community was in an uproar.

Then, in 2000, things began to happen.

The hospital hired a new chief executive, Andrew Craigie, who arrived from Seattle with a vision. Steeped in the ideas of “culture change” or “resident driven care,” a radical new approach to eldercare, Craigie challenged the board of directors and staff to completely revamp what they do, borrowing from Toyota’s management approach (called “Lean”) and others.

The Lean approach, Craigie told me, means you’re always looking at what you do through your customers’ eyes. In health care, that means “face” time: “Are you listening to me?” “Are you responding to my needs?” Wasteful practices reduce face time, so eliminating waste becomes important to improve care and to control costs.

Working closely with staff, the board and residents, Craigie facilitated meetings to examine the central question: What do we do?

They had two goals: improve their environment and improve their care. Since they had no money, they couldn’t remodel, so they started with the care. “A good thing,” exclaims Craigie, because they needed a better picture of what they were doing before they could understand how to upgrade their setting.

In February 2001, the board adopted the concept.

“True culture change runs so deep,” says Susan Morrow, director of nursing and a 27-year employee of the hospital whose family settled in Pomeroy at the beginning of the Civil War. “It won’t happen unless you have the commitment of everyone involved — board, administration and staff.”

Their mission was to create a setting where each individual finds it possible to experience “the healing touch of our community.” Among other things, this includes “the sound of words, music and wind; the smell of fresh-baked pie, hot coffee or a spring rain; the physical touch of a warm blanket, soft hand or hair brush [pulled] gently through your hair — and even the emotional touch of a smile, a wink or kind word.”

It may sound hokey, Craigie admits, but each word was carefully chosen. “The whole care experience,” he says, “is so personal, especially in eldercare.” Though the setting is an institution, the experience should not be institutional, but should reflect the vibrancy of life, warmth and charm, like our homes.

“Our purpose was more than changing the building,” says Craigie. “We wanted to build on the relationships of our town, our residents and their loved ones with the emphasis not on death and dying, but on life.”

Under the “old” way, the hospital did things for the convenience of staff, to make their jobs easier. Today, it strives for efficiency but with heart. Their goals: to improve the quality of care, operational efficiency and clinical performance.

Getting there required hundreds of steps, both monumental and small.

They used the Web and printed materials and held conferences to tell their story to residents, staff, the greater community, regulators and vendors (see They created staff and resident teams to examine their processes. They held Town Hall meetings, inviting the community to get involved. They changed how they operated, then developed ways to measure the impact on resident quality of life, staff satisfaction, family satisfaction and costs of daily operations. They created training systems for all staff to implement their new philosophy.

Then, in 2003, they received a $100,000 grant from the Hulda B. and Maurice L. Rothschild Foundation, a national philanthropy in Chicago, in recognition of their commitment to implement resident-centered care. It was the shot of resources they needed, and they named their strategic plan “Creating Home & Building Community,” after the Rothschild grant of the same name. “There’s no question it’s a fitting way to describe what we are trying to accomplish,” says Craigie.

Next week, I’ll tell you their many amazing victories along the path of radical eldercare reform.

Liz Taylor’s column runs Mondays in the Northwest Life section. A specialist in aging and long-term care for 30 years, she consults with families and their elders. E-mail her at or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at