State Flex Profile Navigation

Montana Department of Public Health and Human Services

Top Flex Activities

CAH Quality Improvement

The Montana Flex Program (MT Flex) encourages public quality reporting through Quarterly Quality Calls, weekly Medicare Beneficiary Quality Improvement Project (MBQIP) emails, a Montana-based manual in printable format, and through the Montana Flex Performance Improvement Network (PIN) website.

To directly impact improvement and provide education, MT Flex focuses on project-based and skills-based education and certification programs. Education to be provided in Fiscal Year (FY) 2019 includes an Excel and professional development learning path subscription and group calls in a “book club” format. Excel training and skills have been an identified need by Montana critical access hospitals (CAHs) for many years and lack of experience in this program leads to great time spent manipulating data and much frustration. MT Flex also offers a professional certification preparation course on a cyclical format. In FY 2018, MT Flex provided a prep course and learning group to a cohort of Quality Coordinators interested in obtaining Certified Professional in Healthcare Quality (CPHQ) credentials, and by doing so, increased the number of CPHQ certified staff members by 12. MT Flex will focus on Certification in Infection Prevention and Control (CIC) for FY 2019 via a collaborate learning format.

MT Flex provides project-based learning for performance improvement in our MBQIP 2 Outcomes (M2O). Annually, a cohort of 10 to 15 Montana CAHs complete a facilitated, targeted improvement project that integrates quality coordinator education, Lean methods, and statewide networking using the foundational elements of a rapid improvement project. The FY 2019 project will revisit care transitions measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and readmission rates. Previous projects included patient satisfaction of care transitions, emergency department (ED) throughput, and Acute Myocardial Infarction (AMI) and ST-segment Eleveation Myocardial Initiative (STEMI) care in the emergency room (ER).

MT Flex will continue to work with the very robust Montana Antimicrobial Stewardship (ABS) Collaborative towards increasing the number of facilities that are meeting the seven core elements of ABS. This past year, the collaborative began work on implementing ABS programs in outpatient settings and will continue this work over FY 2019 by assisting in tracking and reporting of ABS data and providing education. Additionally, MT Flex will be working with a regional cohort of facilities to provide direct pharmacy assistance for ABS Program development and pharmacy review.

CAH Operational and Financial Improvement

Lean internships have been a cornerstone of the Montana Flex Program for many years. Up to eight hospitals are accepted for a two-week rapid improvement project conducted by Montana State University (MSU) Industrial Engineering students in the summer. The students work in conjunction with hospital stakeholders to apply their knowledge of Lean principles and tools to complete an improvement project of the facility’s choice within a two-week period. Project participation provides the opportunity to work on the following activities:

  • Target a specific improvement event identified by the facility

  • Involve project stakeholders in an organized, problem-solving process utilizing Lean methodologies

  • Provide real-world learning experience for MSU students

  • Utilize outside expertise to rapidly complete an improvement project

Over the years, Lean projects have included inventory/supply chain management, charge capture, staff scheduling, food service/dietary systems, admission/registration processes, patient wait times, and workflow.

In FY 2019, MT Flex will contract with the National Rural Health Resource Center to develop a Montana CAH Balanced Scorecard that includes indicators on quality improvement, financial and operational improvement, and population health. Montana CAHs will be invited to participate and provide input into development.

Utilizing Flex funding, the Montana Department of Public Health and Human Services (DPHHS) Trauma Systems will bring in a national instructor to host an Advanced Trauma Life Support (ATLS) instructor course to increase the instructor pool by eight in FY19. Montana lacks the minimum number of instructors required.

CAH Population Health Improvement

MT Flex will be facilitating the Community Access to Mental Health First Aid & Resources (CAMHFAR) program in five CAH communities in FY19. CAMHFAR is a format for convening all community stakeholders, not just CAH staff, to develop pathways and relationships between primary points of contact for those in need of assistance and to offer community members Mental Health First Aid training. The Montana Flex Program is inviting CAHs to take the lead on the project by reaching out to the stakeholders, hosting the training, and gathering the partners at the conclusion of the training to decompress and share resources. In addition, after each training, a community resource guide will be developed and provided to all.

MT Flex actively collaborates with the Montana Office of Rural Health to support up to eight CAHs’ efforts to develop community health needs assessment (CHNA) implementation plans. Implementation plan data is analyzed through the development of a global report to identify areas of need for additional resources.

In addition to Flex activities contracted with the Montana Health Research and Education Foundation (MHREF), DPHHS partners in the Chronic Disease Prevention and Health Promotion Bureau will have activities for Worksite Wellness and Prenatal and Postpartum Breastfeeding Support. The Worksite Wellness will expand to eight CAHs in FY19 and the Centers for Disease Control and Prevention's (CDC) evidence-based programs will be added. Prenatal and postpartum breastfeeding support training will be offered with little to no cost to CAHs. A Rural Train-the-Breastfeeding-Trainer Program will be provided at no cost for up to 10 host CAHs and 10 scholarships for a Critical Access Certificated Lactation Program are available to CAH staff.

Rural Emergency Medical Services (EMS) Improvement 

Montana DPHHS EMS will be utilizing Flex funds and aggressively seeking other funding to complete the comprehensive EMS agency surveys started with the Flex EMS Sustainability Project in FY18.

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

All MT Flex activities are coordinated through the Performance Improvement Network (PIN), which is comprised of all 49 CAHs. Network activities are supported through a PIN listserv, a website, and regional and statewide meetings. MT Flex focuses primarily on cohort work, where hospitals with similar needs work on projects and share project results and processes with the entire PIN.

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

MT Flex is working with a cohort of states to develop an on-demand trustee education platform.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) 3.5

Montana Department of Public Health and Human Services (DPHHS) Rural Hospital Flexibility Program 

Montana Flex Performance Improvement Network Website

Number of CAHs 49

Flex Program Staff

Leslie Howe
Flex Program Manager, Montana
(406) 444-9519

Specialty Areas / Background

Leslie has worked for the State of Montana Department of Public Health and Human Services (DPHHS) since 2000 and has extensive experience working with a variety of community-based service programs and state facilities. She is skilled in team-building, meeting planning, report writing, and quality improvement. Montana DPHHS is the state-designated awardee of Flex Program funding.

Flex Program Manager since March 2015

Jack King
Flex Coordinator, Montana
(406) 457-8016

Specialty Areas / Background

Jack is the Flex Program Director at the Montana Health Research and Education Foundation (MHREF), a division of the Montana Hospital Association. Jack has an extensive background working with critical access hospitals (CAHs), rural health networks, telemedicine, and grant project development and management. MHREF is the primary contractor to the state-designated awardee for Flex Program activities.

Flex Coordinator since July 2017

Jennifer Wagner
Rural Hospital Improvement Coordinator, Montana
(406) 457-8000

Jen began working with MT Flex in 2012 as the Flex Project Specialist. Her background includes experience with MBQIP and data collection and reporting. In her new position of Rural Hospital Improvement Coordinator, which she began in April 2020, she concentrates on developing education and improvement activities for CAH staff. Jen received her Certified Professional in Healthcare Quality (CPHQ) credential in 2019 and is currently pursuing her bachelor’s degree in Public Health.

Lindsay Konen
Flex Program Specialist, Montana
(406) 457-8002

Lindsay Konen started as Flex Project Specialist in June 2020. Skills she brought with her include customer service, budgeting, and running a face-paced and high-functioning department. Lindsay has experience in hospital settings and her degrees are in Business Marketing and Communication Studies.

Kristin Juliar
State Office Director, Montana
(406) 994-6003

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,009,121 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.