State Flex Profile Navigation

University of North Dakota Center for Rural Health

Top Flex Activities

Program Area: Support for Quality Improvement

The North Dakota Critical Access Hospital (ND 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. North Dakota Flex maintains CAH participation in the Medicare Beneficiary Quality Improvement Project (MBQIP). North Dakota Flex collaborates with other quality improvement related initiatives involving North Dakota CAHs and emergency medical services (EMS).

Please share a success story about reporting quality data or using quality data to help CAHs in your state improve patient care.

Patient Safety activity for the Influenza Vaccination Coverage (OP-27)

The North Dakota Flex Program wanted a mode to track CAH activity on the Centers for Disease Control and Prevention (CDC) National Health Care Safety Network (NHSN). In order for the Flex Program to view individual CAH data on this secure website, the Flex Program needed its own NHSN account. Once an account was established, a group under the Flex Program was created on the secure side of the NHSN called "quality." Each CAH was asked to join the group which allowed the state Flex Program to view their OP-27 data. 

The enrollment and reporting process went as follows:

  • ND CAH Quality Network invited CAHs to register for NHSN and join the ND group (discussed at regional meetings and also sent emails)
  • Provided a step-by-step PowerPoint on how to set up for NHSN account and join ND CAH Quality Network group
  • Set up a spreadsheet to monitor who had enrolled, joined, and entered data
  • Monitored group weekly
  • Sent reminders to hospitals not yet set up
  • Closer to submission deadline, made individual calls and provided direct assistance to those not yet set up, or hadn't entered data, which led to 100% participation in the state
  • After the submission date, sent out reminders to the CAHs that they needed to keep their Secure Access Management Services (SAMS) card current by logging in every six months

The NHSN account for North Dakota Flex is now monitored frequently to determine which CAHs have registered for NHSN, and to assist CAHs in meeting data submission deadlines. ND CAHs ended the fall season with 100% (36/36) participation.

Care Transitions - Emergency Department Transfer Communication (EDTC)

North Dakota CAHs report EDTC quality data using a web-based collection, analysis and reporting tool called REDCap, a portal used for data collection. The web-based portal allows patient information to be entered and tracked on how well the information is communicated from an ED to another health care facility. CAHs self-register for an account to allow access to the reporting system. Technical support is provided by the Flex-funded state quality improvement organization (QIO). EDTC data reports are generated through the portal, and sharing of EDTC data occurs quarterly by region as well as one time a year statewide, in which all CAHs come together in one place. Top performers are identified and celebrated at the quarterly meetings. A measure overview of all seven data elements are reviewed quarterly and most frequently missed elements are discussed with a strategy to improve performance. Data submission status for all 36 CAHs has been 100% participation for more than four consecutive quarters.

Program Area: Support for Financial and Operational Improvement

The North Dakota Flex Program identifies CAHs in most need and, through a competitive Request for Proposal (RFP) process, make available a limited number of subcontract awards for financial and operational improvement projects. In addition, North Dakota Flex provides the North Dakota CAH Board of Directors Boot Camp and the Peer Exchange Program. For the Peer Exchange Program, North Dakota Flex 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.

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

  • Assists CAHs in identifying specific health needs of their communities and supports planning and implementation of related activities
  • Assists CAHs with developing strategies for engaging with community partners and targeting specific health needs
  • Assists with building local/regional EMS capacity and performance in CAH communities and improving integration of EMS in local/regional systems of care

Please provide information about Collaboration/Shared Services

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 CAH, local public health units and other community organizations and stakeholders, and promote community engagement and healthy behaviors.

Program Area: Support for Integration of Innovative Health Care Models

  • Establishes a cohort of CAHs using ED CAHPS to improve ED patient experience
  • Assist with care coordination improvement efforts through a cohort of ND CAHs involved in a patient messaging pilot project

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

The North Dakota Flex Program provides a variety of resources and information, and partners with the state QIO and state hospital association to inform CAH staff, leadership and CAH board members about issues relative to the transition from volume to value-based care.

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

The ND CAH Quality Network serves as a common platform for CAHs to share best practices, tools and resources related to providing quality of care. The mission of the network is to support ongoing performance improvement. Goals of the network include improving information sharing and networking at the regional and state level among CAHs, tertiary facilities and other stakeholders to prevent duplication of efforts. All of North Dakota's 36 CAHs are members of the 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.

Please describe how your state Flex Program has enhanced its use of data in the past year.

For both HCAHPS and EDTC, the ND CAH Quality Network facilitates quarterly meetings in which data is shared and reviewed, identifying top CAH performers in the state. The network uses this platform to discuss and share best practices relative to HCAHPS and EDTC areas needing improvement.

Please share any resources or tools that you found useful in your state Flex Program's work this past year that you would recommend to your Flex Program colleagues.

The North Dakota Flex Program has purchased and made available resources created by the Walker Company for CAHs and trustees seeking to ensure their board discussions, deliberations and decisions are well-informed and evidence-based. These materials include topic-specific educational video links, informational "Board Briefs," sample templates, sample manuals, sample job descriptions, etc., and were purchased with direction from North Dakota CAHs, focusing on North Dakota CAH-identified priorities. North Dakota CAHs are free to use these governance education resources with leadership and board members, who are able to access them at any time using their facility-specific login information.

In addition, the Everyone's a Caregiver Mastery Frontline Series - HCAHPS Skills for Everyone, and HCAHPS Nursing Skills is free to each North Dakota CAH, through sponsorship of the National Organization of State Offices of Rural Health (NOSORH). The content is designed to educate, engage and empower everyone to provide a world-class, compassionate patient experience in just one hour a month for 11 months.

Program Statistics

Type of Organization University
Staffing 6.0 FTEs
Number of CAHs 36
Website URL Organization Website

Flex Program Staff

Gary Hart, PhD
Director, Center for Rural Health, North Dakota
(701) 777-3899

Specialty Areas / Background

  • Rural health
  • Health workforce (physician, nurses, oral health personnel)
  • Rural geographic taxonomies
  • Access to care
  • Rural, state and federal policy
  • Rural healthcare for the elderly, infants and the underserved

Center for Rural Health Director since October 2010 

Lynette Dickson
Associate Director/Community Outreach and Engagement, North Dakota
(701) 777-6049

Specialty Areas / Background

Lynette directs the State Office of Rural Health (SORH) grant program, Medicare Rural Hospital Flexibility (Flex) program, Small Rural Hospital Improvement Grant Program (SHIP), Area Health Education Center (AHEC), other workforce related projects and a health information technology (HIT) project funded by Medicaid. She is currently appointed, by the Governor, to the North Dakota HIT Advisory Committee and serves as chair; as well as the ND Emergency Medical Services (EMS) Advisory Committee. In addition, she serves as the director of the Area Health Education Center program office. As part of the core function of the programs listed above she provides direction to projects related to HIT, workforce development, recruitment and retention; and is actively involved in health policy, government affairs, community development, strategic planning and grant development.

Associate Director since March 2003 

Brad Gibbens
Deputy 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
Flex Coordinator, North Dakota
(701) 858-6729

Specialty Areas / Background

As a Senior Project Coordinator, Jody coordinates the activities of the North Dakota Medical Rural Hospital Flexibility (Flex) program administered by the Center for Rural Health at The University of North Dakota (UND) School of Medicine and Health Sciences. She has been with the Center since 2008. 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 Coordinator since January 2013

Kylie Nissen
Senior Project Coordinator
(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.

Special Projects Coordinator/Internal Evaluation since August 2016

Angie Lockwood
Project Coordinator, Center for Rural Health, North Dakota
(701) 777-5381

Specialty Areas / Background

Angie Lockwood is a Project Coordinator for the Center for Rural Health. Angie works with a diverse team that provides support to rural hospitals and their partners throughout North Dakota. Her role includes program coordination, providing outreach and technical assistance, tracking budgets, reporting on program outcomes, and information collection and dissemination.

Project Coordinator since January 2014

Julie Frankl
Project Assistant, North Dakota
(701) 777-6781

Specialty Areas / Background

Julie Frankl is a Project Assistant at the Center for Rural Health at the University of North Dakota (UND) School of Medicine and Health Sciences in Grand Forks.

Project Assistant since March 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.