University of North Dakota Center for Rural Health


United States

Top Flex Activities

CAH Quality Improvement

The North Dakota (ND) Critical Access Hospital (CAH) Quality Network hosts quarterly meetings to facilitate the exchange of state survey findings between CAHs. Best practices, policies, and other resources are shared to help CAHs prepare for their surveys and to help develop a plan of correction if necessary. The North Dakota Flex Program maintains CAH participation in the Medicare Beneficiary Quality Improvement Project (MBQIP). The North Dakota Flex Program collaborates with other quality improvement related initiatives involving CAHs and emergency medical services (EMS).

CAH Operational and Financial Improvement

The North Dakota Flex Program identifies CAHs in most need through a competitive Request for Proposal (RFP) process and makes available a limited number of subcontract awards for financial and operational improvement projects. In addition, the North Dakota Flex Program provides ongoing education around various topics including Medicare compliance, billing and coding, Board of Director's Boot Camp, and the Peer Exchange Program. For the Peer Exchange Program, the North Dakota Flex Program provides travel support for individuals or small groups to meet with similar entities from other areas of the state and share information, ideas, and successful approaches to improving quality and access to health care services. 

CAH Population Health Improvement

North Dakota's Flex Program's activities related to this area include:

  • Assisting CAHs in identifying specific health needs of their communities and supports planning and implementation of related activities
  • Assisting CAHs with developing strategies for engaging with community partners and targeting specific health needs

The North Dakota Flex Program, through a competitive RFP process, makes available a limited amount of funding to support programming that addresses a significant need identified by the hospital's most recent community health needs assessment process. These projects encourage collaboration between the CAHs, local public health units, and other community organizations and stakeholders, while they promote community engagement and healthy behaviors.

Rural Emergency Medical Services (EMS) Improvement

Through ongoing partnerships with various stakeholders, as well as a subcontract with the state EMS Association, the North Dakota Flex Program assists with building local and regional EMS capacity and performance in CAH communities and improving integration of EMS in local/regional systems of care. Activities related to this area include:

  • Facilitating meetings between CAHs and EMS agencies to strengthen regional communication channels among EMS agencies and CAHs
  • Providing EMS management conference and training courses for EMS leaders
  • Conducting behavioral health training sessions for EMS and nursing staff
  • Offering National Association of Emergency Medical Technician's (EMT) EMS Safety Courses
  • Assisting EMS agencies by providing them technical assistance and conducting strategic planning sessions for those agencies
  • Providing EMS Leadership Training

If your Flex Program was funded for one of the eight competitive Flex EMS awards, please describe your project, your partners, and intended long-term outcomes.

The primary purpose of this North Dakota Flex EMS Supplemental proposal is to implement a demonstration project on data collection and reporting for a set of rural-relevant EMS quality measures. The process will directly involve rural EMS agencies, providers, and enhanced training. Rural EMS in North Dakota is in the early days of employing a new electronic platform for data collection and submission; therefore, this initiative will enhance the utilization of the new system.

The North Dakota Flex Program will partner with the North Dakota EMS Association and North Dakota Department of Health, Division of EMS to establish a reliable foundation for quality improvement, based on active participation and engagement from the rural EMS community. Identified subject matter experts (SMEs) and agencies will be engaged in the selection of rural relevant measures that will involve a multi-step process involving an assessment and review from the state data repository and comparisons with a national rural EMS database. During this process, the SMEs will be involved as part of a structured focus group looking at data/metric gaps, and prioritization and ranking of rural metrics. Each of the SMEs will be trained as mentors and will work directly with a cohort of two to four rural agencies, which will provide them the opportunity to work and learn in small group settings.

Continuous training will be made available via the Project ECHO platform, using videoconferencing to build local skills and capacity in data collection, as well as how to use the data to improve processes and quality of EMS care. Ultimately, the North Dakota Flex EMS Supplement project will allow benchmark comparisons of North Dakota quality measures through reports to the ESO Solutions national dataset that will inform the development of rural-relevant quality measures.

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

The North Dakota CAH Quality Network serves as a common platform for CAHs to share best practices, tools, and resources related to providing quality care. The mission of the network is to support ongoing performance improvement. Goals of the network include improved networking and information sharing at both the regional and state level among CAHs, tertiary facilities, and other stakeholders to prevent duplication of efforts. All 36 North Dakota CAHs are members of this network. An executive committee of CAH representatives serve as a decision-making body and provide leadership to the members, as well as oversee the network's efforts. A stakeholder committee, represented by statewide partner organizations, provides feedback and a link to increase communication.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization University
Staffing (FTE) 6
Website Organization Website
Number of CAHs 36


Organization Contacts

Brad Gibbens

Acting Director, Center for Rural Health, North Dakota
(701) 777-2569

Specialty Areas / Background

Brad Gibbens is the deputy director of the Center for Rural Health at The University of North Dakota (UND) School of Medicine and Health Sciences and an assistant professor at the School of Medicine and Health Sciences. His primary areas of responsibility are community development, community engagement techniques, program development, and health policy.Gibbens works closely with health policy, government affairs, community development (including assessments, strategic planning, and community engagement), program and grant development, and information dissemination activities. Center programs that address community development include the following: State Office of Rural Health, Rural Hospital Flexibility, Small Hospital Improvement Program, Blue Cross Blue Shield of ND Rural Health Grant Program, small program evaluation, and the Dakota Conference on Rural and Public Health. 

Deputy Director since January 1988

Jody Ward MS, RN, APHN

Program Director, North Dakota
(701) 858-6729

Specialty Areas / Background

Jody Ward is a Program Director with the Center for Rural Health at the University of North Dakota (UND) School of Medicine and Health Sciences (SMHS). She directs activities of the North Dakota Medicare Rural Hospital Flexibility (Flex) program, Small Rural Hospital Improvement Program (SHIP) and ND Critical Access Hospital Quality Network.  Jody has been with the Center since 2008 and her office is based in Minot, N.D.

Jody has led the North Dakota Critical Access Hospital Quality Network in a number of quality and patient safety initiatives and serves as a liaison to statewide stakeholders, facilitating the exchange of information and network development through the Flex program. Jody has a Master of Science degree in Advanced Public Health Nursing (APHN) from the University of North Dakota and a registered nurse (RN) Bachelor's degree from Minot State University, Minot, North Dakota.

Flex Program Director 2020-Present. Sr. Project coordinator 2013-2020. Project Coordinator 2008-2013.

Jody Ward

Kylie Nissen

State Office Director, North Dakota
(701) 777-5380

Specialty Areas / Background

Kylie assists in the coordination of the activities for the State Office of Rural Health, the Medicare Rural Hospital Flexibility (Flex) program, Area Health Education Center (AHEC) and other workforce related projects. She is also the principal investigator of the Blue Cross Blue Shield of North Dakota rural health grant program and coordinates the Scrubs Academy and Scrubs Camps, HIPAA certification and the Dakota Conference on Rural and Public Health. She currently serves on the National Organization of State Offices of Rural Health Board as treasurer.

Nicole Threadgold

Project Coordinator, North Dakota
(701) 330-3264

Nicole Threadgold is a project coordinator with the Center for Rural Health (CRH) at the University of North Dakota School of Medicine & Health Sciences in Grand Forks. Nicole's responsibilities include coordination of the North Dakota Medicare Rural Hospital Flexibility (Flex) program and Small Rural Hospital Improvement Program (SHIP) activities as well as assisting with the Community Health Needs Assessment process. Before joining the CRH, Nicole was the foundation director and marketing coordinator for CHI St. Alexius Health in Carrington, North Dakota.

Flex Coordinator since December 2020

Anna Walter

Project Coordinator, North Dakota
(701) 213-5336

Anna Walter is a project coordinator for the Rural Health Clinic Network, the North Dakota Medicare Rural Hospital Flexibility Program, and the Critical Access Hospital Quality Network at the Center for Rural Health at the University of North Dakota (UND) School of Medicine & Health Sciences.

In this position, Anna is developing a Rural Health Clinic Network to support, educate, and provide resources for ongoing performance improvement for North Dakota Rural Health Clinics.

Anna previously worked as the executive director of the Nelson County Health Services Foundation and Program Development at Nelson County Health System. Originally from McVille, North Dakota, Anna earned a bachelor's degree in business administration with a minor in marketing/communications at UND in 2008.

Ashley Folarin

Project Assistant, North Dakota

Ashley Folarin is a project assistant with the Center for Rural Health (CRH) at the University of North Dakota School of Medicine & Health Sciences in Grand Forks.

Ashely's responsibilities include working on the Flex project and Project ECHO. Before joining the CRH, Ashley worked at Altru Health System, Cleveland Clinic, Sanford Health, and other private practices in urban areas.

Originally from Gales Ferry, Connecticut, Ashley attended the University of Connecticut.