State Flex Profile Navigation

University of North Dakota Center for Rural Health

Top Flex Activities

Program Area: Support for 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).

Program Area: Support for Financial and Operational 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 the CAH 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. 

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

The ND CAH Quality Network continues work with a cohort of CAHs using Emergency Department Consumer Assessment of Healthcare Providers and Systems (ED CAHPS) to improve ED patient experience. 

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

To continue toward support of the transition to value-based models and transformation efforts in the health care system, the North Dakota Flex Program will make available technical assistance for select CAHs to study and implement or improve care coordination processes. 

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 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 36 of North Dakota's 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.

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

The North Dakota Flex Program works with the Illinois Critical Access Hospital Network (ICAHN) on ED CAHPS. ICAHN also serves as a vendor to seven North Dakota CAHs for Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) vendor services.

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

For both HCAHPS and EDTC, the North Dakota 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.

Do you have any hospitals interested in converting to CAH status?:


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 

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

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

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 Specialist, 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 Specialist 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.