Nebraska State Flex Profile

Top Flex Activities

Program Area: Support for Quality Improvement: 

The Nebraska Flex Program uses the Baldrige framework for improving quality and the overall performance of critical access hospitals (CAHs). This model is used because it emphasizes the importance of leadership in changing the culture of the organization and improving communication at all levels. There is also a strong focus on customer satisfaction and measuring results. The key activities under quality improvement are:

  • Support CAHs participating in the Medicare Beneficiary Quality Improvement Project (MBQIP)
  • Continue to support the training and implementation of Capture Falls within the CAHs
  • Conduct mock surveys
  • Support participation of CAHs in an annual quality conference in Nebraska

In order to improve MBQIP scores, Nebraska staff are working with the Nebraska Hospital Association, the University of Nebraska Medical Center, the quality improvement organization (QIO) and the CAH networks to identify best practices and share these practices in all of the CAHs.

Please share a success story about reporting quality data or using quality data to help Critical Access Hospitals (CAHs) in your state improve patient care: 

Nebraska subcontracts the Capture Falls Program, which includes a series of projects to improve the safety and quality of care in CAHs. The Capture Falls Program now includes a web-based reporting system where participating CAHs report and track fall incidents. Participating CAHs participate in developing action plans, regular learning conference calls with project managers, training webinars and site visits to establish their Capture Falls program. The web-based reporting system allows them to enter all incident data and pull real-time reports for their facility.

Program Area: Support for Financial and Operational Improvement: 

Good financial performance is also based on the elements in the Baldridge framework. For example, good leadership and open communication throughout the organization will enhance both operational and financial improvement. The key activities within this area are:

  • Provide training and education to CAHs on Lean management techniques, including an online version of the course
  • Provide technical assistance on the implementation of Lean projects
  • Conduct comprehensive financial and operational assessments for low or negative margin CAHs
  • Providing a Finance 101 course targeting frontline staff at CAHs

Once the financial and operational assessments are completed, a tracking system is developed to assess the progress and changes in meeting the recommendations contained in the report. Follow-up visits are made to determine progress and any additional technical assistance needs.

Program Area: Support for Population Health Management and Emergency Medical Services Integration: 

The Nebraska Flex Program is enhancing emergency medical services (EMS) capacity by assessing the trauma system within the state. A subcontractor completed a comprehensive assessment of the state's trauma system. An engagement process was utilized to bring together stakeholders to gain their input into the process. A final report is being developed and will identify strengths and areas for improvement, including recommendations.

The Nebraska Flex Program is supporting strategies that will lead to a strong regional system of care for patients who need immediate treatment for a heart attack. The Office of EMS is working with key stakeholders to develop a statewide cardiac plan to improve the outcomes of ST-segment elevation myocardial infarction (STEMI) patients. When the plan is completed, the Office will work with the stakeholders to set target goals for implementing the strategies, provide technical assistance to help the community achieve the target goals, and evaluate the implementation activities to determine if the target goals have been achieved.

Please provide information about Collaboration/Shared Services (specifically connected to population health management): 

The Flex Program works closely with the Office of EMS staff, identifying technical assistance needs and venues for meeting those needs. Members of local EMS systems are invited to participate in regional CAH network meetings.

Please provide information about any efforts to assist CAHs/communities and partner organizations in the transition to value-based care: 

The Nebraska Office of Rural Health hosts an annual Rural Health Conference which targets health providers at all levels. The agenda this year included several sessions focusing on value-based care and the transition process. Nebraska also hosted a day-long seminar on CAH leadership that included the future of value-based care in CAHs.

Please provide information about network activities in your state to support Flex Program activities (such as financial improvement networks, CAH quality networks, operational improvement with CEOs or EHR workgroups): 

The Nebraska Flex Program uses six CAH networks which range in size from two to 26 members. The networks consist of CAHs and one large regional or urban hospital. The networks hold regular meetings with member CAHs to share information and identify technical assistance needs. Each network has one to two network coordinators that lead the process. The network coordinators all participate in quarterly Network Coordinator Meetings facilitated by Flex staff. The purpose of these meetings is to network, share best practices and information and identify technical assistance needs. The Flex Program sponsors and the Quality Steering Committee to monitor all things quality. Regular meetings are held to review current data submissions, identify technical assistance needs and share best practices.

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

Several of the CAH networks include member hospitals from bordering states. These CAHs participate in all network activities.

From the last Flex Program year, please describe a best practice you would like to share with other states: 

The Nebraska Flex Program continues to support Lean management training, which is subcontracted to also provide technical assistance. All participating CAHs have completed at least one Lean project. In addition to greater efficiencies, the application of Lean principles has created better working relationships and enhanced the collaborative partnerships within the hospitals.  

A lesson learned is that there is a relatively steep learning curve, and with limited staff it is difficult to expand training throughout the organization. In order to overcome this challenge, a three-and-half day Lean Six Sigma Green Belt Certification Program has been developed, offered first in August 2013. The purpose of the course is to expand the number of CAH staff that have the knowledge and skills to apply the Lean management principles. With more people trained, there is greater potential to not only increase the number of Lean projects, but also generate greater cost savings and improve the quality of care. An online version of the training was released in 2016. 

Program Statistics

What type of organization is your Flex office housed in?: 
State Government
What is the number of full time employees (FTE) in your Flex office?: 
How many CAHs are in your state?: 
Do you have any hospitals interested in converting to CAH status?: 

Additional Information

Flex Program Staff

Margaret Brockman
State Office Director, Nebraska
(402) 471-6057

Specialty Areas / Background

Margaret Brockman joined the Office of Community & Rural Health in July 2013. As a registered nurse, she has been employed in both rural and urban hospitals.She has experience in Medicaid, Patient Centered Medical Homes, Nursing Education, Certified Case Manager, Certified Occupational Health Nurse, commercial insurance, workers compensation and as a private business owner of a healthcare consulting firm.

State Office Director since July 2014

Nancy Jo Hansen
Flex Coordinator, Nebraska
(402) 471-4616

Specialty Areas / Background

Nancy Jo Hansen joined the Office of Community and Rural Health in December, 2014. Prior to joining the Rural Health Team, she spent 20+ years working in the field of HIV prevention and health promotion. Nancy Jo served as a team member of the HIV Prevention Program at Nebraska Department of Health and Human Services where she worked closely with community members and local public health agencies. Nancy Jo also served as the Program Coordinator for the HIV Prevention Program at the Nebraska Department of Education where she worked with local school personnel to develop HIV prevention curriculum.

Flex Coordinator since December 2014

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, $1,100,000 (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.