Chair File: Leadership Dialogue — Importance of Advocacy and Storytelling in Rural Health with Lori Wightman, R.N., CEO of Bothwell Regional Health Center

00:00:01:05 - 00:00:23:09
Tom Haederle
Welcome to Advancing Health. In the face of today's multiple challenges, every hospital needs support and buy in for its mission of great care. Storytelling - sharing the right kinds of stories with the right audience at the right time - is a great way to build and maintain that support. This is particularly important for rural hospitals and health systems, most of which have razor-thin operating margins.

00:00:23:12 - 00:00:40:10
Tom Haederle
In this month's Leadership Dialogue, hosted by the American Hospital Association's 2025 Board Chair Tina Freese Decker, we hear more about the importance of advocacy and of all team members participating in telling the hospital story.

00:00:40:13 - 00:01:07:25
Tina Freese Decker
Thank you so much for joining us today. I'm Tina Freese Decker, president CEO for Corewell Health, and I'm also the board chair for the American Hospital Association. Last month we talked about trust and how our hospitals and our health systems can strengthen that trust with our communities and the people that we serve. Our rural hospitals are uniquely positioned to do this, as they are often the largest employers in their towns and communities, and frequently the only local source of care.

00:01:07:27 - 00:01:28:07
Tina Freese Decker
Rural health care is about being a family. We take care of each other in our communities as best as possible, and we're here to provide that care close to home, no matter what headwinds that we all face. I recently had the opportunity to attend the American Hospital Association's Rural Conference and you could really feel that sense of family and community in the room.

00:01:28:09 - 00:01:59:15
Tina Freese Decker
We work in hospitals in red states and blue states all across the country, but we are all focused on the same thing: helping our neighbors in our communities to be healthier. There are some big challenges that are facing real health care, but together with a unified voice, we can get what we need. As I have traveled around our country meeting with the American Hospital Association's regional policy boards and visiting the rural hospitals and my health system and others, the number one concern that I have heard from our hospitals, our communities, is access.

00:01:59:18 - 00:02:22:28
Tina Freese Decker
And that is why it is so integral to the American Hospital Association strategy and it is why it is so important that we come together as a field and that we're united as a field, because these challenges that we are facing are real. So today, I am pleased to have a distinguished leader in rural health care with us to talk about how we can all work together to advocate for the needs of our hospitals.

00:02:23:01 - 00:02:45:09
Tina Freese Decker
I'd like to welcome Lori Wightman. She is the CEO of Bothwell Regional Health Center, a 108 bed acute care hospital in Sedalia, Missouri. Laura has served in this role since 2019, but even prior to Bothwell, she worked in real health care as the president of Mercy Hospital Ada in Ada, Oklahoma. So, Lori, welcome. Glad you were able to join us today.

00:02:45:15 - 00:02:46:17
Lori Wightman, R.N.
Thank you, Tina.

00:02:46:19 - 00:03:03:20
Tina Freese Decker
And I wanted to start out with just telling us a little bit about yourself. I know you started your health care career as a nurse and then you made the shift to administration. Can you tell us about yourself and how you see that family aspect in the hospital and the community in our rural areas?

00:03:03:22 - 00:03:30:01
Lori Wightman, R.N.
Sure. Well, my father was a hospital administrator and my mother was a nurse, so I did both. And so it was a natural progression. And I think the foundation that nursing lays gives you all kinds of transferable skills that have been very helpful as I went into hospital administration. My career and dating advice has always been, you can't go wrong with a nurse.

00:03:30:03 - 00:03:57:14
Lori Wightman, R.N.
And there's certainly served me well. And you talk about that family atmosphere. That is why I continue to choose rural health care. I've done the CEO position in a suburban hospital, and I sat at our senior leadership team meeting and thinking I was the only one on our senior leadership team that even lived in the area that we served.

00:03:57:17 - 00:04:23:24
Lori Wightman, R.N.
Everyone else lived in a different suburb, and I just thought that was strange and disconnected. And, so I returned again then to rural health care because it is like a family. And it's ironic because we just finished revisiting our mission, vision and values. And our new mission statement talks about together we work to provide compassionate and safe care to family, friends, and neighbors.

00:04:23:27 - 00:04:37:07
Lori Wightman, R.N.
Invariably, when I met new employee orientation, a significant number of people were born at the hospital. That's why I love rural. It's like that "Cheers" phenomenon where everyone knows your name.

00:04:37:09 - 00:05:01:02
Tina Freese Decker
Very true. I used to lead a couple of rural hospitals as well. And like you said, even just walking into a rural hospital it feels like family where everyone there knows your name and of course, protect things from a confidentiality and a privacy perspective, but that feeling that we're all in this together. So I love that your mission statement is about together, that you can make an impact on people's health.

00:05:01:05 - 00:05:13:28
Tina Freese Decker
I described a little bit about what it's like to walk into a rural hospital. Can you share a little bit about what is like to be a rural hospital, what it means in today's environment and why it's such a great place to work?

00:05:14:01 - 00:05:47:06
Lori Wightman, R.N.
Well, in many ways, rural hospitals are uniquely the same as our suburban or urban counterparts. Forty six million people depend on a rural hospital for their care. So we struggle with the same labor shortages, the cost of labor supplies and drugs is rising faster than our reimbursement. We have all of those same struggles. Unique is that family atmosphere, I think.

00:05:47:06 - 00:06:13:26
Lori Wightman, R.N.
And we have multiple generations working at the hospital. Now, you can't say anything bad about anyone because invariably they're somehow related. Or they were best friends in high school, or they used to be married to each other. So I mean, it's unique in that way. We have the same types of struggles that  our counterparts do.

00:06:13:28 - 00:06:18:03
Tina Freese Decker
What pressures are you feeling the most acutely right now?

00:06:18:06 - 00:06:47:09
Lori Wightman, R.N.
Well, you take all of those common challenges that I talked about, and you turn up the volume a little bit. Because for us, 78% of our patients and our volume is governmental payers, so 78% of our business, we're getting reimbursed below cost. You can't make that up in volume. So we rely on all of the governmental programs, you know, disproportionate share all of those things.

00:06:47:09 - 00:06:54:22
Lori Wightman, R.N.
And, 340B is doing exactly for us what it was designed to do, save rural hospitals.

00:06:54:25 - 00:07:11:22
Tina Freese Decker
Those areas are critical that they remain. And so that we can continue to provide that sustainable, high quality care in our communities and all of our communities. 78% being governmental. It's a huge portion of what we do and what we rely on for access and caring for people.

00:07:11:29 - 00:07:23:15
Lori Wightman, R.N.
Right. We are the typical rural hospital. We have razor-thin margins and aging plant of 18 years.

00:07:23:18 - 00:07:31:10
Tina Freese Decker
So those are challenges that you're trying to navigate right now with all of the other things that happen. And how is your staffing levels going? Are those going okay?

00:07:31:13 - 00:07:55:12
Lori Wightman, R.N.
Have the same labor shortage issues. We still have 22 traveling nurses here, but we have started being very aggressive in a grow your own program. And so as soon as the next month we're going to cut that number in half and then, within six months, we're hoping to have all of contract staff out.

00:07:55:15 - 00:08:02:04
Tina Freese Decker
Is that something that you're most proud of, or is there something else that you want to share that you're most proud of from a rural hospital perspective?

00:08:02:06 - 00:08:29:24
Lori Wightman, R.N.
I think what I'm most proud of is you get to personally view the impact of your decisions on people. I'm very proud of our all the talented people that we have here, from clinicians to community health workers. All of our physicians get to use all of the things they learned in medical school and residency, because there isn't a lot of subspecialists, so they are working at the top of their license.

00:08:29:26 - 00:08:50:21
Lori Wightman, R.N.
Just several months ago, one of our critical care physicians diagnosed a case of botulism. Now as an old infection control nurse I get very excited about that because I never thought in my career I would see botulism. But it was diagnosed and treated here and the person's doing well.

00:08:50:23 - 00:09:25:27
Tina Freese Decker
Oh, that's wonderful to hear. When you talk about all the different people that are part of health care in rural settings, or also another settings, it's quite amazing to see how many different areas we need to come together to take care of our community. When you think about an even larger scale, from rural hospitals to urban and teaching hospitals and others, how do you think about the whole ecosystem of our field and how we, you know, do we need all of us or and is there a way to form that greater fabric and social connection, or is there something else that we should be doing?

00:09:25:29 - 00:09:50:21
Lori Wightman, R.N.
We are all very interconnected and I believe we are all needed. And I especially feel that as an independent hospital, not part of a health system, this is my first independent hospital. I rely on my hospital association more than I ever did when I was working for a health system, because it all comes down to relationships.

00:09:50:21 - 00:10:18:13
Lori Wightman, R.N.
And so how do you develop, how do you get yourself in situations where you are meeting and now working with your partners around the state or the region? Because it comes down to relationships, you really need to know who your neighbors are in terms of other hospitals, who you're referring your patients to and develop that working relationship because it is all interconnected.

00:10:18:13 - 00:10:25:06
Lori Wightman, R.N.
And we rely on our partners that we refer to, and they rely on us, too.

00:10:25:08 - 00:10:43:23
Tina Freese Decker
One of the things I heard you say about the Rural Health Conference that the American Hospital Association just put on, and the value of the American Hospital Association is that we're not alone. And those values of relationships are really critical. So I appreciate that. The American Hospital Association also talks a lot about how do we tell the hospital story.

00:10:43:25 - 00:10:55:15
Tina Freese Decker
So how do you engage in advocacy to make sure we're telling that hospital story so that our legislative leaders and others know the value that we're bringing to the community?

00:10:55:17 - 00:11:22:11
Lori Wightman, R.N.
Well, we are surrounded by stories. And so the first thing is to always be picking up on what is the story that is surrounding us, and how can we capture that? Because the most effective way is to bring that patient or nurse or physician to the legislator to testify, because they are the most effective way of communicating a message.

00:11:22:18 - 00:11:49:07
Lori Wightman, R.N.
You know, the suits can go and talk about data, but nothing is more effective than what I call a real person telling their story and how a decision or a potential decision is going to impact them and how it feels. The other thing we do is every October, it's become tradition. We have Advocacy Day with our board, at our board meeting.

00:11:49:09 - 00:12:21:12
Lori Wightman, R.N.
We invite our state elected officials  - so people representing us at the state capitol - to come to our board meetings. On election years their challengers also come and I invite the hospital association and they all answer two questions: What do you hope to accomplish in the next legislative session, and what do you think might get in the way? That sets the scene for my board to understand that part of their role in governance is advocacy.

00:12:21:14 - 00:12:29:19
Lori Wightman, R.N.
And so I've had two of my board members...almost every legislative session I go and testify on on some bill.

00:12:29:21 - 00:12:50:01
Tina Freese Decker
That is really a good idea. Thank you so much for sharing that. Do you have any other final suggestions for us as AHA members, as other hospitals, whether it's rural or urban, that we should think about or do as we think about advocacy and access or also field unity?

00:12:50:03 - 00:13:22:11
Lori Wightman, R.N.
You know, having been on the board of two different state hospital associations, I get it. You know, sometimes members can be at odds with each other on a given issue. And my advice to AHA would be to play the role of convener, facilitating conversations between members to better understand each other's position. And if a middle ground can't be reached, then that might be an issue that AHA remains neutral on.

00:13:22:14 - 00:13:34:07
Lori Wightman, R.N.
But there are so many issues where we can agree on and that is very much the role and what all of us depend on AHA to play in advocating.

00:13:34:09 - 00:14:02:15
Tina Freese Decker
There's a lot that binds us together. Like you said, we're all caring for our neighbors and our communities, and that's the most critical piece of it. And we have to keep that front and center with every decision that we make and every action that we do. Well, Lori, thank you so much for being with us today on this AHA podcast, for sharing your expertise in rural health care and for talking about some new ideas that all of us can take forward to ensure that we're telling the hospital story in the best way possible.

00:14:02:18 - 00:14:21:09
Tina Freese Decker
So while I know that we have our work ahead of us, I know that I continue to be energized every time I speak with committed and passionate hospital leaders like Lori. Again, appreciate your work that you do every single day for the neighbors and for the people in your community that you serve. We'll be back next month for another Leadership Dialogue conversation.

00:14:21:13 - 00:14:23:01
Tina Freese Decker
Have a great day.

00:14:23:03 - 00:14:31:13
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.