Clinical Oversight Transforms Care at Tribal Hospitals

Providers at Native American health facilities face an overwhelming number of problems. Clinician shortages, outdated technology, a scarcity of necessary supplies and resources, lack of clinical oversight, and inadequate funding are major barriers to quality patient care. But Tribal EM is out to change all that.

When CEO and founder, John Shufeldt, MD, first began working in tribal health, he made a startling discovery: transforming care for Native American communities might be much simpler than people realized. There are no easy fixes for funding inequities and provider shortfalls, but he saw another solution that could make all the difference: a committed group of people focused solely on caring for tribal populations.

Dr. Shufeldt’s realization was the impetus for launching Tribal EM. The company’s goal from the beginning? To bring a private healthcare model to Native American hospitals and health systems.

Staffing: More than a Fill-the-Gap Approach

Most staffing agencies that serve this population simply send clinicians to plug holes. It is ineffective in every possible way. Not only are providers working in remote areas, away from friends and family, they are not given support once they arrive. Providers want to help their patients – that’s why they entered healthcare in the first place – but such situations are impossible. There’s no one to call for help, as most staffing agencies sign off once the assignment is filled. This creates an extremely high degree of burnout and turnover.

Tribal EM’s approach to staffing is a complete departure from other agencies. In addition to staffing highly qualified clinicians, the company goes to great lengths to take care of their people. This includes rich benefits, transportation and housing, and even a tuition reimbursement program called Tribal Education Advancement Merit Scholarship (TEAMS).

Perhaps most important, Tribal EM provides the support clinicians need to do their jobs and do them well.

Planning that Improves Processes and Care

When Tribal EM begins working with a new hospital, their first step is to perform a top-to-bottom assessment of the facility. From there, the company implements an ongoing and data-driven quality assessment and performance improvement plan. This includes a metric-managed approach to improving culture, efficiency and quality, and specifically addresses lengthy wait times, low morale, turnover, poor service quality, and other areas that negatively impact patient care.

Supporting Staff with Clinical Oversight

Executing the plan means managing the entire care delivery process. Tribal EM employs chief medical officers, medical directors, chief nursing officers, and chief clinical officers who oversee quality initiatives, patient care. and structured chart review, and possess the clinical expertise to support staff across the health facility.

Tribal EM is the only staffing agency that provides clinical oversight. This effort doesn’t just improve patient care – it helps hospitals stay open. Despite a deplorable lack of healthcare access in tribal areas, many emergency departments have shut down or are at risk of closure by CMS due to noncompliance and substandard care. It’s a Catch 22 – everyone agrees that care must improve, but closing down the ER puts patients in grave danger. This is especially true in rural areas, where patients may not survive transport to far-away hospitals.

The Data Tells the Story

With quality measures and clinical oversight in place, Tribal EM helps facilities improve patient outcomes and care. In one emergency department, the average “door-to-provider” wait was 184 minutes when Tribal EM was first hired. Now, the average time to see a provider is 18-22 minutes – an improvement of nearly 750%. Meanwhile, length of stay decreased from 532 minutes to 108 minutes, even while patient volumes rose 18%. These are among the most important measures in emergency medicine. They now align with national standards for care.

With clinical oversight that elevates standards of care, combined with many other efforts to improve the health status at native health facilities, Tribal EM is bringing a private healthcare model to tribal communities.

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