SITUATION

For any hospital, regardless of size, leadership, staff satisfaction, and performance go hand in hand. When one area goes unchecked, other areas potentially suffer. As the saying goes, “Complacency is the enemy of progress,” and all hospitals must be vigilant about the risks associated with operating at a place of “business as usual” mindset rather than focusing on continuous improvement.

Hendrick Center for Extended Care, was the former name of a long-term acute care hospital (LTACH) operated by Hendrick Medical Center in Abilene, Texas. The LTACH was not operating at an optimal level, so Hendrick Medical Center reached out for assistance to address key areas needing improvement.

BACKGROUND

Community Hospital Corporation (CHC) owns and manages LTACHs. Newly named ContinueCARE Hospital- Abilene in 2025, the not-for-profit 23-bed LTACH located within its host hospital, Hendrick Medical Center, Abilene, Texas, is poised to serve Abilene and surrounding counties in the West Texas area. Since aligning with CHC ContinueCARE, the LTACH has achieved accreditation by the Center for Improvement in Healthcare Quality (CIHQ) and excellence awards in Long Term Acute Care, Respiratory Therapy, and Nursing.

In its current location since 2014, the LTACH serves patients with medically complex conditions, especially those needing extended recovery times—a hospital stay that’s often 25 days or more. After care in an LTACH, many patients then transition to acute rehab, skilled nursing, or they return home. Services at ContinueCARE Hospital-Abilene include a pulmonary program for ventilator weaning, a medically complex program for patients requiring intensive care, and a long-term wound care program.

As a “hospital-within-a-hospital,” ContinueCARE Hospital- Abilene is a separate yet fully licensed hospital partnered with the sponsoring hospital to succeed. However, in order for both entities to thrive, they need to work and collaborate together.

By 2018, it became clear that the LTACH was struggling with census around 13–14 of its 23 beds. Area hospitals were referring patients elsewhere due to slow response times and poor communication. Employee recruitment and retention rates were down, and 75–80% of nursing staff were contract labor who were less invested and more costly than full-time nurses. Multiple factors challenged leadership to transform operations, workflow issues, staffing and a culture of inclusiveness.

“LTACH is an ever-changing industry, changing from one month to the next, but I don’t feel like I need to go to every single conference or read every single journal because we can turn to CHC. It’s almost like ongoing mentoring.”

Brian Bessent, Chief Operating Officer, Hendrick Medical Center South

PLAN

Built on the foundation of a solid partnership and commitment to success, CHC ContinueCARE began the turnaround by completing an operational assessment and evaluation of all levels of the organization. In small hospitals, it is critical to have hands-on leaders that are in their role to serve and support the community that the hospital serves. Servant leaders build servant-minded teams by making leadership changes at the hospital level.

The team “started from scratch,” according to April Myers, Senior Vice President of Post-Acute Operations for CHC. “They took an ‘out of the box,’ approach to address areas for improvement focusing on two key areas: employee satisfaction and service quality as outlined in the following initiatives.”

Focus on employee retention & recognition

CHC partnered with Human Resources to develop and implement an action plan to boost employee retention and satisfaction, including:

• New leadership model: Implementation of a Transformational Leadership Model, focused on providing staff with an arena to voice concerns and offer input.
• Recognition program: Creation of a recognition program to celebrate birthdays, name an employee of the quarter, and show employees they are a vital part of the team.
• Internal training: Establishment of an internal training program for ICU nurses instead of using an external agency as had been done previously.
• Workflow updates: Examination of workflow issues, taking into account nurse and physician feedback about tools, skills, and working environments needed for success.

New commitment to quality service

In addition, the LTACH launched a quality initiative centered on improving service by taking the following steps:

• Met with regional hospitals in the area to learn how to better serve them and then redesigned processes and procedures based on feedback.
• Formed the Early Mobility Program, a program focused on getting patients out of bed as quickly as possible. The nurse-driven plan freed up rehab staff and gave patients access to therapy seven days a week rather than five.
• Established an internal wound care program focused on aggressive modalities and early identification of potential skin breakdown using a thermal imaging equipment called WoundScout.

Increased communication

Lastly, the hospital made the following communication improvements:

• Began involving employees in order sets and other decision-making processes to help the team understand the issues and identify solutions.
• Provided information to staff about the critical importance of prompt response to referral requests and patient admission. • Established monthly staff meetings to increase employee involvement.
• Shared more patient success stories with physicians and the referral team.
• Improved communication across the admissions team, clinical liaison team, case management, and clinical teams.
• Regular meetings with the key providers to provide an open line of communication and.

The Results

As a result of these initiatives, the LTACH reports that the leadership team is stronger and engaged, and patient and physician satisfactions have improved. The LTACH is on a continuous improvement path, operating efficiently and with an improved average daily census.

Measurable improvements

The hospital has reported the following measurable improvements in 2025:

• Average monthly referrals and admissions increased from Hendrick Medical Center hospitals and outlying areas.
• Caring for higher acuity patients as indicated by an improvement in Medicare Case Mix Index from 1.15 to an average of 1.28 in 2025
• Decreased length of stay for managed care patients from 25 to 23.2
• Total operating costs per patient day decreased by 6.6% from FY 2019 to FY 2025 and continue to meet targets • Better management of accounts receivable improved cash flow; outstanding AR days decreased from 74 to 40 in one year and ended at 37 in 2025.
• EBIDA margin improved from a negative (3.3%) for 2019 to a positive 6.9% for 2025.
• Improved Patient Satisfaction as evidenced by Google rating score of 4.7 in 2025 from 3.7 in 2023.

“Our employees wanted the hospital to be successful, ” Myers says. “They were part of the solution, and they are proud to be part of the ContinueCARE Hospital-Abilene care team.”

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