Officially in charge, Goshe sees positive change at RDH

RANGELY I Since coming to Rangely District Hospital in January 2008, Nick Goshe has seen many changes.
And things are still changing. But in a good way.
That hasn’t always been the case.
“It’s been an interesting couple of years since I’ve been in town,” Goshe said.
The 35-year-old Goshe officially took over as chief executive officer of the hospital in June, after serving a six-month apprenticeship under interim CEO Merrill Frank.
The announcement that Goshe would take over as full-time CEO came at the end of last year. He was originally hired as the chief nursing officer.
Seven months later, in July 2008, then CEO Jason McCormick and the hospital parted ways. McCormick had been CEO since January 2006.
“Jason hired me, but he was not liked in the community,” Goshe said.
Enter Frank, who came out of retirement to serve as interim CEO. It was his second stint at the hospital. He had previously served as CEO from January 1997 to October 1999.
One of Frank’s assignments as interim CEO was to find a permanent replacement. Not long after returning to Rangely District Hospital, Frank identified Goshe as the right man for the job.
“He started dropping little hints,” Goshe said. “It was pretty clear the direction he wanted to go.”
When Frank came in, Goshe was pretty much the last man standing, at least as far as the hospital’s administrative team.
“I was the only member of the administration left when he came in,” Goshe said.
The high turnover rate did give him some pause about taking the CEO’s job.
“It makes me wonder, the number of CEOs who come and go here … but, so far, it’s going well,” said Goshe, who was first promoted to chief operating officer and designated as the CEO-in-training. “So, we’ll see.”
Soon after Frank came on board, the transition started, with Frank serving as a mentor for Goshe. Frank still attends monthly board meetings and will continue to serve as a consultant through the end of the year.
“Merrill did a great deal of work laying a good foundation,” Goshe said. “He did a good job of preparing me.”
Not that Goshe didn’t inherit a challenging situation.
“We’ve had a problem with physician turnover here,” Goshe said. “So we started asking them (the doctors) what doesn’t work here. We’re making strides.”
Two new doctors have been hired — Chris Adams and Karyl Ting. A new physician assistant — Candy Campbell — was hired to oversee the emergency room and handle second-shift calls. And a new physicians’ schedule was implemented, with the aim of providing more consistent patient care, not to mention allowing doctors to work more regular hours.
“I think patients will like the fact (doctors) will have a fixed work week (for scheduling appointments),” Goshe said. “The doctors are excited about it, too. That seems to be a trend across the country — they want to have more of a fixed schedule. The doctors will still be called out (after hours) for anything major, but it makes it nice (to have a physician’s assistant) for the routine orders.”
Emergency-room visits to the hospital have been trending upward for years. Which, in the past, could lead to burnout for overworked doctors.
“In the ER, we went from having 30 or 40 patients a month to 120 or so, and last month we had 168,” Goshe said. “(ER visits) have increased double digit for the last decade, and most of those fall after hours.”
Under the previous schedule, doctors were on 12 days, then off nine.
“But during that 12 days on, there was a lot of on-call time,” Goshe said. “If you worked in the clinic all day and then in the ER at night, it would be hard on anybody. It would be hard on me, too, if I worked ER all night and worked at the clinic all day.”
Goshe knows whereof he speaks. He’s been there, done that.
He may be a full-time administrator now, but Goshe has been on the front lines. He knows the demands and pressures placed on doctors and nurses. He understands what they’re going through. He’s one of ’em.
“I have a pretty good understanding of what the clinical needs are, and I can relate to the doctors and to the nurses,” Goshe said. “Up until I moved into the CEO role, I always had some patient care. Slowly, as I’ve moved up, (his role) has become less (hands on) and it’s become more administrative, but I can still relate to them, and I think that helps.”
Goshe says Rangely District Hospital is fortunate to have hired Drs. Adams and Ting as well as Campbell, the physician assistant.
“Candy (Campbell) done a lot of work in rural areas, so a place like Rangely is not foreign to her. Her whole career has been rural medicine,” Goshe said. “Dr. Adams has been practicing medicine for seven years. He’s coming from Pennsylvania. But he’s into rock crawling, and he likes hunting and fishing. That’s what attracted him to us. Hopefully he’ll be starting in the next month. We’re just waiting for him to finish up his Colorado licensing.
“Dr. King has been working in the Denver suburbs for the last 27 years. Her husband works in Moab (Utah). He’s a climatologist. She was looking for something that offered five days a week, and she was looking for a small town. That’s what attracted her to us,” Goshe added. “She will be starting Oct. 26. I think the town will like both of these doctors.”
Recruiting to a remote area like Northwest Colorado has its challenges.
“We had some good fortune to find some doctors who were interested in our opportunity,” Goshe said, also noting Dr. Brenda Hinton, who joined the RDH staff last fall. “It’s very hard to recruit. There’s a shortage of family medicine docs. You have to have a little bit of knowledge about everything. It’s not for everybody, but there are people who like this sort of practice, and that’s who we’re trying to find.”
Goshe hopes the new docs will like Rangely as much as he does. He and his family, who moved here from Ohio, have felt at home in Northwest Colorado. He and his wife, Starleen, have three children ages 6, 4 and 20 months.
“We like it,” Goshe said. “We like a small town. This feels like a nice, family-oriented town.”
With the staff stabilizing, with new doctors coming on board, with patient numbers remaining steady, with the finances in order, things are looking up for Rangely District Hospital, even in these tough economic times.
“Since I’ve been here, the hospital has had a very strong cash position,” Goshe said. “Right now, we’re in the best cash position ever. The patient numbers have not dropped. They’ve been very strong, right around where we budgeted for.”
Along with all of the changes, Goshe sees the community’s perception of the hospital also improving. And that’s a positive change.
“I sense that we’re doing better,” he said. “Community attitudes are changing, I hope. We’ve been making some strides, and I think the community sees that.”