Mikaela Kienitz, Boone County Hospital, Chief Executive Officer, September 1, 2026

Today I’m visiting with McKayla Keenett, CEO of the Boone County Hospital, and McKayla, thanks first for taking some time to visit with us. Thanks for having me, Jim. Hey, we had a lengthy break. I keep telling people there’s a lengthy break between when the board last met and their last meeting, which was of course right here at the end of August, but June was the previous last board meeting. But you do have the executive committee. You’ve got finance committee. You’ve got committees, and they’re well aware of what’s going on at BCH. Yeah, the committees are keeping in touch all the time throughout those breaks that we have. We also combine our meetings closer to Thanksgiving and Christmas as well. But July is always kind of a time when we do generally take a break and folks are, we have board members on vacation, admin team members on vacation, so it’s just, you know, we’re finishing up the year. We’re starting a new budget. So there’s just a lot going on. I feel like I had a super long list of things to talk about with the board this month, so I was really excited to see them again. It was, and that’s the big thing too, because getting them all together there at the same time, that’s when you get a lot of the direction. Yeah. Obviously, big thing, bought land, and I guess we’ll talk about that and really start it because most people are aware of this. Me with Boone County Economic Growth Corporation, they secured the option for you and went ahead with the purchase of land. So right away, you know, people are going, well, when’s this going to happen? And I’m going, this is only the beginning. This is very early in the process. Yeah. You know, acquiring the land is really kind of a next step in thinking about the future development of the hospital and the hospital campus and, you know, health care is constantly evolving. And so we’re always looking at what is it going to take to keep up with the needs of you know, the people that we serve and what kind of technology and what kind of spaces are we going to need. And so we’ve been doing some facility master planning for a few years now as you’re aware. I don’t we talk about whenever we chat, but, you know, we’ve been looking at everything from doing nothing to building new and ultimately the board hasn’t made a decision of what we will do, but we do think that acquiring land just gives us more options in the future. So we’re pretty excited about this next step and hopefully we’ll see some future movement on what actually the facility master plan will look like here in the next few months. And that’s one of the things that for listeners, just so they understand, you work on these plans and you put this together, still need to go back to the state and say, here’s what we think we need for Boone County. Yeah. We still have to keep working through, you know, licensing things and all the different there’s a lot of different pieces that go into this and it takes a long time to kind of decide what can we do, what can we afford, what type of square footage do we really need, what kind of, what would it cost if we renovated the facility and did everything we needed and what are the, you know, the benefits of renovating and staying here versus trying to do new versus, you know, the long-term impact that it would make when we think about, you know, our property that we currently own, we’re kind of in the middle of a residential area and so there’s so many factors that we have had to consider throughout this process and it’s been a really good process for us, it’s forced us to look at our service lines and really understand things, but, you know, our current building is aged, it’s older and it’s got some older infrastructure in it and so we’ve had to take all of that into consideration as we’ve looked through this process. Yeah, and they need to remember the newest addition is over 20 years old now, so. Yeah, I think it was added in 2000, so 26 years old and it, you know, we’ve outgrown it. Oh, yeah. In that new addition and it’s too small and that’s a good problem for us to have, it’s just how do we move forward from here is really the thing that we’ve all been taxed with. Well, a lot of work yet to do on that and again, that’s one of those things where those are decisions that are made by the board and will be done, you know, that’s one of the things that they are tasked with doing, they have to do that, so. You know, it does take a bit because I think the board wants to make sure to do their due diligence as they should and so it’s, there’s a lot of detail to iron out and I know people would like to have an answer of what, what are you going to do and, and I think we know, you know, kind of the path we want to go down, but we have to make sure to evaluate all of the pieces that go into that prior to making a final decision. Well, let’s talk a little bit about how we wrapped up the fiscal year 26 and I know you got the dashboard for that. I have my version. Yeah, but, but again, at the end of June, when the board met, we still didn’t have all the numbers to finish up the year, but when you get down to it after that, and Angie was able to accumulate all the numbers, kind of give you some final numbers. There are areas where you still would like to see some improvement. I think really the big thing is you had a lot of very successful numbers that came out. A lot of goals were met. A lot of goals were met. I think that, you know, all in all, I would say that fiscal year 26 for Boone County Hospital was a wonderful year. Revenue-wise it was our best year ever. We ended the year with just a little under $9 million to our bottom line and so that was really, really good for us. We’ve seen a lot of growth and we talk about surgery, you know, our surgery was down for, one of our ORs was down for about three months at the year. We still saw the same number of surgeries as we saw the year before, so that growth was recognized. You know, we saw a close to 50,000 visits in PT, OT, and speech and so, you know, we just continue to see that growth, 7,000 visits in our ED, so overall it was a really good year. We were able to serve a lot of people, which is, you know, what our mission is and so that was really exciting, but yeah, you know, on the goals dashboard, our patients’ likelihood to recommend, we did really, really well with that this year. That needle’s kind of hard to move and so we ended the year at, you know, over 90 percent and so really, really proud of that score and we’ll maintain that goal going into next year again because it’s a nationally benchmarked goal and one that we can easily say, hey, this really does indicate the experience that folks are having. We like to use that goal and then we had a number of quality and safety goals and we met a couple of those and then there was a couple that we didn’t meet, but we did. I think we felt like we made some improvement or kind of stayed the same. Our primary C-section rate stayed around 20 percent. I think we were hoping to get that closer to 16 and then we did do a survey on our staff. We did some training on communication and when we hand patients from one care provider to the next and those kind of things and that score did not get quite as high as we wanted it to so we’ll be working on that again this year as well. And then we reduced our employee injury event and we were successful and that one we got only 26 and of course we’d like to have zero, but we know there’s going to be things that happen and so our goal was to decrease employee injuries and we did achieve that so we were pretty excited about that and then a couple other highlights, you know, for the year finance, we eliminated $251,000 worth of waste and so we had a goal of eliminating $250,000 worth of waste and that can come in many different forms so we asked our staff to kind of look for areas that either we’re wasting money and can save some money by doing something differently or doing a contract differently or it might be steps we look at, you know, is there inefficient processes, those kind of things and then we can tie dollar amounts to that so we’re just having them watch for all kinds of waste in their work processes.

And then we also, you know, one of our big goals this year and we’ve been working on it for several years is improve employee satisfaction with competitive wages and benefits so we really want Boone County Hospital to be a great place to work and we want people to be rewarded for that work and so our goal this year was to get 75% of our staff agreeing that we have competitive wages and benefits and we achieved 80% this year and so that was a really big win for us. Like I said, we’ve been working on that for probably about three years now and I think we’re really, really sitting in a good position this year. We’re going to focus on hopefully getting a top workplace designation through the Des Moines Register so we’ll see if the 80% score translates to a top workplace designation or what other areas we need to continue to work on for that and then engagement in our community so we did our goal was 185 service related events and we did 195 so we continue to see that score increase and you know that 195 is probably not representative of all of the activities that we did because we do have to turn those in and if they don’t turn them in then we don’t count them and so we know that there’s probably a little bit more stuff that got done than that but you know and I’m pretty passionate about us being out and engaged in our community and you can see that the growth and the partnerships that have developed through that and I think that just will continue to grow especially with our focus on public health. I think that we’re going to see a lot more community engagement as we move forward so those are some of the highlights on fiscal year 26 and our organizational goals. I know that the part you mentioned again about the handoff communication that one you’ve been on the nursing side of it you know how important that is to make sure that patients understand and whoever’s going to be providing care next knows what’s been happening and what’s going on. Yeah and you know we did this it’s called a team step training and we did that early in the actually in the calendar year so in January we had some folks come and do some training about understanding a specific method that we share communication between care providers and with the patient and their family members and so I think that training was really good. I think we have a little more work to do to make sure that it’s always being used and hardwired so that’s where we’re going to focus our efforts this year is on continuing that but it is very important in preventing errors and that’s what we really want to do we want patients to have a good safe experience while they’re here and so that’s why we’re focusing on that. Well a couple of other things that came up and I wanted you your comments on of course is the foundation I think I mean the transition in leadership there Rachel having been a big part of working with Sarah for so long did not slow down one little bit. Not at all I think every event that has occurred since Rachel took over has seen growth she’s done such an amazing job leading the foundation and in transitioning into that role. I think one of the things that I’m most proud of is the increase in the employee campaign that we do each year we work with our employees and let them know you know what it means to support the foundation and contributing to that and so she’s seen a lot of increase in that and I think that that’s really important we can’t expect people out in our community to support our foundation if our own staff don’t and so seeing the growth in our employee campaign has been really meaningful. In addition she’s done a lot with Project Be the Light here in the last few months especially with we had strikeout cancer she’s got a swimming event coming up in the fall so she’s been working real hard on that and we’ve had a couple of more applicants in that so we do want to make sure we get the word out that there are funds available if people need them and and you can nominate a family member or you can yourself apply for that for those funds and so if as long as they qualify for the funds then we approve that and and those funds are there to help folks and so that has grown a lot and that’s been really nice to see and then both Tressel Hussle and Trivia Knight did really well this year also so it’s really exciting to see the foundation continuing to thrive and and grow and and that their their support for the hospital is amazing they help us to get equipment and and things that we need to function and they’re very supportive and so that’s been really good and then Harvest Festival that was good to say tickets on sale now yes they went on sale today I think for the Harvest Festival coming up in November on November 13th and it’s going to be a around the world theme and so somewhat different where there’s stations instead of kind of sitting for most of the event so it’ll be interactive and I think it’s going to be really fun and one thing I think I know she pointed out the board was that this it’s not it’s not just for a select few this is everybody everybody out of Boone County that would like to help support the foundation because all these dollars you get end up going back into the hospital yes absolutely every penny that they get they end supporting us and and giving those back to the hospital those dollars don’t go anywhere else and so it does help everyone and and we try to spread our events out throughout the county so that various people can participate in them but we do we really are looking for that engagement from everyone and we would love for everyone to come to the Harvest Festival but we do have a couple of other things I wanted to hit on because it’s been a little while first let’s talk about staffing because I know that that’s one of the things you’ve been looking at you talked about staff retention and stuff but you do have people that are retiring and you do have people that are moving and that’s one of the big things that it keeps going on we still have recruitment going on and you still and I think taste has been real busy on the recruiting physicians part yeah you know physicians have been a little bit challenging to recruit and I don’t think that’s been typical for the hospital and so she spent the last year so working pretty hard on recruiting just looking for various physicians that do different things right so some of our providers take inpatient call and help cover in the hospital while some of the others do OB services including C-section some do GI procedures so there’s a lot of variation in what our family practice docs do but she’s spent a lot of time recruiting in this last year and I think that you know the shortage of physicians is sort of rearing its ugly head and and across the country I think they’re just struggle to find physicians and so she’s been working on this pretty hard and I think she’s been successful you know we’ve got one candidate that grew up here in Boone and so we’re pretty excited to get her on board and we have another candidate with ties to the area and so we’re excited to get her on board and so I think in the next year too we’re going to see a lot of additions to our medical staff but it has been a challenging road and and you know people are just shifting gears a lot folks are like hey I want to go work in the ER I want to have a different experience and we want to keep those folks within our system so as they shift around it’s it’s making more openings and and coverage concerns and things like that we’ve been working on adding a hospitalist someone who just takes care of patients in the hospital to try to alleviate some of the call for the family practice doctors and have that more dedicated person that is spending time just doing hospital things so it’s been it’s been a really interesting probably six months or so with looking at our model and and seeing some of those things change and and thinking about again like we talked about earlier with the facility project thinking about the future of our organization and the future of healthcare and what that’s going to look like for us what are our big goals what do we want to achieve and what kind of physicians is it going to take to do that and so we’ve had to do a lot of you know deep thinking about what what the future looks like so that’s kind of the physician front there the other staffing that you’ve kind of talked about as you know we have ongoing nursing staff considerations we’re always recruiting for nurses whether it’s ed nurses ob nurses inpatient nurses and the nursing shortage also is is a struggle and we have great staff and we have very dedicated folks same with physicians you know we’re really lucky to have the people that we have on board we just need to add to it but uh i did want to say we know dr. Hernandez has decided to go a different direction we do have some changes on the orthopedic side as well that we’ll look at yeah that’s true dr. Hernandez her last day is um september 25th i believe so later uh here in the next month um and she is going to be moving away and so we are hiring uh pa to go over to the opt-in clinic but in the meantime before that person gets started we’ll have some of our other um app staff kind of trained uh rotating through the opt-in clinic to make sure that there’s coverage here janelle will still be there um but yeah i mean there’s this kind of this constant shifting of folks and so we want to make sure that that clinic has really good coverage in this sort of time of flux but um so that’s happening um in the opt-in clinic and then we have dr. Zayed is leaving capital and and ultimately i think that um we’ll probably go our own route with orthopedics and hire an orthopedic surgeon um that’s our own employee and so excited to see where that goes but we know that there’s going to be a transition and and some flux with that as well obviously and it’s a position those are positions in great domain i mean they just are hard to find i mean you know to we i think we talked to someone recently that said uh a recruiting company and they said you know it’s an average of like 300 days to place the orthopedic surgeon and to find one so it could be you know uh we’ll continue to work with capital they’re not going to leave us an alert or anything like that until we find someone um but it could be a little bit before we get that position filled well we uh we’ll keep working on that one that uh i find interesting and i did want to make sure that i talked about because i know uh there are people that will make use of this service but you uh have we have ship counselors back we do yes we were one of a few counties that didn’t have um ship counselors and ship stands for senior health insurance information program and so um we have two folks and they’re volunteers and they are signed up and they’ve done their training and so what happens is they it’s a place where people can um come sign up with them and get education on you know medicare and signing up for medicare and the advantage plans and all the different um it’s just to make people aware we don’t make recommendations we just educate and so we’re excited to have that back at the hospital i think folks have been probably traveling to aims for that service and so it’ll be really nice to have that here in in the hospital building and and people can come and and meet with that person and and get that information and uh first nurse been going pretty well first nurse has been going really well um i think we’ve had probably close to 80 calls that have gone to personal since we started that in june um it has you know a lot of those calls are folks questioning what they should do in a certain scenario and then they are able to go ahead and get a hold of our ed physicians that help make decisions if they don’t know the answer to a question and so it’s been really nice to have that um sort of extra help available well we got a lot of things that are going on more racing at the speedway uh puffer billy days you got all these other things and i know you’ll guys will have entries oh i was going to say public health has now taken over the auxiliary has kind of i i’m not going to say go out of way they focus more on a few other things but they’ve been doing blood drives with life serve for a long time but a lot of the people that were heavily involved with that have stepped away and uh again public health stepped up and took over they’re going to start going to cobblestone it does look like they’re going to go to the cobblestone and and um that’s where the the life serve folks will be and so i think that’s going to be a nice option for people to go out and get their donate their blood there um the auxiliary did step away from it and and public health stepped up and it’s going to be the coordinator we simply coordinate it with life serve it’s really a life serve um event yeah event but we help coordinate it and get the word out to folks here when it’s going to happen and help get people signed up and that kind of a thing so it’s definitely something that the hospital does want to be involved in and it’s it’s obviously vital for what we do here so um we’re happy to be doing that and then like you mentioned you know super nationalists is coming up the farm progress show we have uh emergency medical services staff at the farm progress show upper billy days is coming up there is a lot happening right now especially for our ems team we’re going to go stay hydrated yeah that’s well we got to do what we got to do it’s going to be warm it is it is so many other things going on i do appreciate you taking time visiting with us and letting us know uh how things are progressing and uh once again we’ll get back to uh just trying to continue to keep growing all the services that we’ve got and again the for the big thing is uh people we do have our uh we got our walk-in clinics we’ve got our clinics our physicians i think dr holmes is what going to go over and do some obi in augton too dr holmes will be going over to she’ll be the medical director in augton and she’ll be doing some obi and sort of urgent care stuff at augton once a week so that’s a really exciting um transition there too well we’ll keep plugging along and do what we can yep we’ll keep growing thanks so much for visiting with us and i’ll talk to you again next time thanks jen