Hawaii Department of Health, Office of Primary Care & Rural Health


United States

Top Flex Activities

CAH Quality Improvement

The Hawaii Flex Program continues to provide technical assistance (TA) to its nine critical access hospitals (CAHs) on the Medicare Beneficiary Quality Improvement Project (MBQIP) and other quality improvement (QI) initiatives. Every other month, members from the state's CAHs join Hawaii Performance Improvement Collaborative meetings to learn, share experiences and frustrations, provide peer support, and review measures on quality improvement and patient safety. Hawaii has also established a Learning Action Network (LAN) to address specific issues from CAHs, which meets monthly via video teleconferencing (VTC). Individual TA is provided to the CAHs as needed.

CAH Operational and Financial Improvement

The Hawaii Flex Program provides TA on operational and financial improvement through a meeting every other month that addresses financial and operational issues. The nine CAHs meet to learn, share their experiences and frustrations, provide peer support, and review financial and operational measures. The Hawaii Flex Program also supports a Studer Leadership Initiative to better promote Studer principles throughout the CAHs. A monthly LAN on the revenue cycle addresses the key concerns of CAHs on the revenue cycle process. Individual TA is provided to the CAHs as needed.

CAH Population Health Improvement

The Hawaii Flex Program continues to provide TA on conducting community health needs assessments (CHNAs) to CAHs and provides resources and data concerning their communities. The Hawaii Flex Program continues to develop the Pilinaha model that was adapted from the Prevention Institute's Tool for Health and Resilience In Vulnerable Environments (THRIVE) and to support the Blue Zones initiative in rural communities.

Rural Emergency Medical Services (EMS) Improvement

The Hawaii Flex Program is working with the Hawaii Trauma Program to develop an ECHO Trauma curriculum to improve the delivery of trauma care in remote areas.

Please provide information about network activities in your state to support Flex Program activities.

Hawaii has a long-standing performance improvement collaborative that meets quarterly (changed to bimonthly due to the pandemic) to provide opportunities for the CAHs to meet, learn, and discuss issues they are dealing with or may soon be dealing with. There are two distinct parts to this collaborative: one focuses on quality improvement and patient safety while the other focuses on finance and operations. In addition to the collaborative, the Hawaii Flex Program has established a number of LANs that meet monthly through VTC and have a focused issue they address. To date, they have had LANs on clinic transformation, swing-bed improvement, and revenue cycle improvement. Additional LANs will be developed as needed. The Hawaii Flex Program also participates in the Hawaii Trauma Network, state anti-microbial stewardship collaborative, and is working to have CAHs be a part of teh Hospital Quality Improvement Contractors Initiative (HQIC).

Please provide information about cross-state collaborations you may be working on related to the Flex Program.

Hawaii has worked with California in the past to provide ICD-10 training to the CAHs in both states. The program keeps in close contact with other state programs to identify opportunities for collaboration and has provided information to other programs when requested. Hawaii also works with several states to help develop the agenda for the Western Region Flex Conference, which is led by Nevada.

Please describe how your state Flex Program is reaching out to non-traditional partners to support its work.

The Hawaii Flex Program, as a part of its work with Blue Zones and others, has several contacts within the food systems community. This includes farmers, Food Baskets, ranchers, fishers, grocers, and others to improve the quality and availability of locally produced, healthy foods. The Flex program is also working with a Community Action Network in Hawaii County to better address the social determinants of the population.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) 1
Website Organization Website 
Number of CAHs 9


Organization Contacts

Scott Daniels

Flex Coordinator, Hawaii
(808) 961-9460

Specialty Areas / Background

  • Health information technology
  • Public policy
  • Performance measurement

Flex Coordinator since September 2005 

Gregg Kishaba

Rural Health Coordinator, Hawaii
(808) 586-5446