By Tim Gardner
Carmen Lacey, President of Charles A. Cannon, Jr. Memorial Hospital in Linville, has worked in healthcare in Avery County for more than 30 years. Highly-regarded for her excellent leadership, clinical and management skills as well as her kindness and deep compassion for patients, Lacey’s first role as a healthcare practitioner in Avery County was as a staff nurse at the old Sloop Memorial Hospital after completing her Associates Degree in Nursing from Western Piedmont Community College. She went on to further her education by earning a Baccalaureate of Nursing degree from Winston-Salem State University and a Masters of Nursing degree from Gardner-Webb University. Lacey also holds a Certificate in Nursing Administration from the American Nurses Credentialing Center.
She worked in several positions at Sloop Hospital including staff nurse, supervisor and assistant director of nursing, until its merger with Cannon Memorial in 1999. She had duties in almost every area of clinical operations at Cannon Memorial, including Director of the Medical/Surgical Unit, Restorative Care and New Life Center as well as Director of Nursing, before becoming president.
Continue reading for a conversation between this reporter (my questions) and Lacey (her answers) about various topics, including her views of the top changes she’s witnessed in healthcare, her extensive service in other public service fields and what she considers Cannon Memorial’s top challenges in the upcoming years.
High Country Press (HCP): For those who want to learn more about you, what is your personal background?
Lacey: I was born at the old Cannon Memorial Hospital in Banner Elk. I am the middle child of Russell and Nellie Singleton. My brothers are Tommy (Montezuma), David (Belmont, NC) and Dennis (Morristown, TN), and my sister is Laura Wright (Lawndale, NC). I grew up just across the county line in Burke County, so I attended Avery County Schools. I am married to Mike Lacey, and we have 3 daughters – Melynda (Mindi) Kosmos, Laura, and Taylor. We have one granddaughter, Caroline Jordan (CJ) Kosmos.
HCP: You have a long and varied history working in healthcare. What triggered your interest in making that your chosen profession?
Lacey: Pharmacists Bob and Linda Taylor hired me at Crossnore Drug Store, which they own, while I was still in high school. I knew that I loved working with people and all things healthcare were very interesting. I then began working as a Pharmacy Technician at Sloop Memorial Hospital, and nurses Pam Jameson, Eula Johnson and Lorene Cuthbertson became my role models. My decision to attend nursing school was largely based upon their influence and I’m still in awe of their knowledge, compassion and expertise!
HCP: What have been the most noticeable or biggest changes in healthcare that you’ve witnessed first-hand during your 30-plus years working in the profession?
Lacey: There are so many. I’ll focus on just a few that have had the biggest impact upon me.
When I began nursing, it was common practice for patients to bring their suitcases with them when they came to the doctor or the Emergency Department because they could request admission and it usually happened. We were then paid what we billed. Over the years, payment changed to a pre-determined amount based upon the diagnosis. Now hospitals are increasingly being paid based upon the quality metrics that payers set.
Another big change is within the nursing and medical staffs. Nursing staff in settings such as ours were expected to have expertise in medical surgical nursing, as well as cover the Emergency Department, obstetrics and critical care nursing. At the time this worked, but advances in medical care and medications make this very difficult now. Specialty nursing within hospitals is the “norm,” with nurses working primarily within one department.
Primary care physicians within the community used to take care of the hospital inpatients, while also seeing patients in his/her office every day.
As you can imagine, this takes a toll on physicians who worked 16-20 hours day, and their families who might not see them for days. The model now is “hospitalist” care – a provider whose specialty is the care of patients while in the hospital. They then hand off care upon discharge to the primary care physician in the community. Many might see this as a negative because “their” physician is not caring for them while in the hospital. However, this actually allows the community physician to focus on the patients within their practice while maintaining a work/life balance. The care within the hospital has improved because the hospital provider has more time to focus on the needs within the hospital, as well as to plan for needs upon discharge.
Perhaps the biggest change for the community was closing both Sloop Memorial and the old Cannon Memorial and moving the “new” facility in Linville. There were so many ties that the community and staff had to these facilities – births, deaths, and the many people who dedicated their lives to one or other of the facilities. There was recognition of leadership at that time that health care was changing, and that a community the size of ours could not support two separate hospitals. As difficult as this was, it was certainly most beneficial to Avery County to have a singular hospital than to have both hospitals fail.
HCP: Charles A. Cannon, Jr. Memorial Hospital is managed by the Appalachian Regional Healthcare System, headquartered in Boone, and which includes Watauga Medical Center, Blowing Rock Hospital and Appalachian Regional Medical Associates. How did it happen for you to become Cannon’s president and how long have you served in the position?
Lacey: I have been in my current position since 2012—one that I never visualized myself in. I was quite content in my nursing leadership role at the time I was asked to consider being President. Chuck Mantooth, current Chief Executive Officer (CEO) of Appalachian Regional Healthcare System, approached me regarding the position and indicated both the ARHS administration and the chair of our Board of Trustees had indicated their confidence in me. My initial reaction was “absolutely not”. But I care about healthcare in Avery County, and I came to see that my role could be to ensure that we always have high quality and appropriate healthcare services.
HCP: How would you define being a successful and productive hospital president?
Lacey: My success is defined by the staff that I surround myself with. We have an excellent staff with a commitment to the community and to providing great care. My goal over the course of my tenure is simply to ensure that we continue to have those core services that small rural communities need – the emergency department, inpatient medical care, laboratory and radiology services. We also recognize that there is a behavioral health crisis within the state and nation, and our decision to expand our inpatient behavioral health beds was based upon the needs that we have seen.
HCP: What are the most rewarding aspects of your work—both professionally and personally?
Lacey: Professionally, it is knowing that we meet a need within the community. It is also being part of the larger community that impacts health care by partnering with the YMCA, the Avery County School system, Mayland Community College, Lees-McRae College and Avery County Health Department, among others.
Personally, I take pride in knowing that my ultimate motivation is to ensure CMH is here after I am not.
HCP: What are your specific responsibilities as hospital president?
Lacey: I am responsible for CMH – I take responsibility for the quality, safety, and all other metrics for which we are measured – both internally and by state and federal entities. Mr. Mantooth calls me a “processor”. I don’t like to make rapid judgements – I need to consider all of the implications when making a decision that impacts patients and staff.
HCP: Is your general work schedule and duties basically the same every day or is each day different to an extent?
Lacey: Every day is different – I might “plan” on getting a list of things done during the course of the day, and none of them get done because something unexpected or more pressing comes up. Critical thinking and prioritization become important during these days!
HCP: Approximately how many people does Charles A. Cannon, Jr. Memorial Hospital serve each year?
Lacey: Thousands, between the Emergency Department, our diagnostic services, inpatient care (both medical and psychiatric), outpatient behavioral services and our therapy departments – Physical, Occupational and Speech.
HCP: What do you consider the hospital’s top accomplishments while you’ve served as president?
Lacey: 1-Being awarded $6.5 million dollars from the state to expand our inpatient behavioral health beds. I anticipate that the expansion will create 50-plus jobs within our community; 2-Developing relationships with key resources within the community, including the county commissioners, the county manager, health department, school system and the YMCA; and
3-The award of a Care Transitions grant by the Duke Endowment to decrease admissions. The grant funding ended a couple of years ago, but we continue to utilize some of the processes that were put into place and have succeeded in keeping the overall readmission rate low.
HCP: What are the greatest challenges for Charles A. Cannon, Jr. Hospital during the next couple of years and into the new 2020 decade?
Lacey: The challenge for CMH is the same as with the hundreds of other rural hospitals around the country – identifying core services that are important to our communities and continuing to provide them, while recognizing that the current and future healthcare culture does not allow us to be all things to all people. The payer system is becoming increasingly complex, and having to choose what our community needs versus what we want is the evolving reality.
HCP: You work at the leisure of the Appalachian Regional Healthcare System (ARHS) Board of Directors and Administration, and you supervise many healthcare employees at Charles A. Cannon, Jr. Memorial Hospital. You also work with many hospital volunteers, donors and other patrons. What comments would you offer about the many people who work individually, yet collectively, as a team for the betterment of the ARHS and Cannon Memorial Hospital?
Lacey: I am proud to know and work with these people. I can’t imagine that there is a more committed group of folks anywhere – the staff, the volunteers, the board, and administration work as a team and that’s what keeps me coming back every day.
HCP: You’re a quintessential and long-time goodwill ambassador for Avery County and the North Carolina High Country. What are the medical and other public service organizations you’ve been active in and are still a part of?
Lacey: The Williams YMCA of Avery County – current board chair; Avery County Chamber of Commerce – current board chair; Avery County Economic Development Committee – appointed by the Board of Commissioners; Avery County School Health Advisory Committee;
Mayland Community College Nursing Program Advisory Committee; Lees McCrae College Nursing Program Advisory Committee; Healthy Carolinians; North Carolina Hospital Association Regional Policy Council; and Graduate of inaugural Leadership Avery program.
HCP: What additional comments would you like to make to all who read this article?
Lacey: There have been a lot of rumors about CMH becoming “just” a behavioral health hospital. Behavioral Health is a great need and we will be helping to meet this need, but it is also important that everyone know that we will continue to have services that we currently offer, including inpatient medical beds, emergency department, laboratory, radiology, therapy and surgical services.
As healthcare continues to change, I recognize that it is impossible to offer every service – it is just not feasible. And it’s not necessarily the financial implications, but more about quality and safety. I would love to still have obstetrical care at CMH, but this was just not possible without risking the entirety of CMH. Every decision that is made is fully vetted by not just me, but the entire administrative team and the determination of the total impact.
Yes, we are expanding behavioral health beds from 10 to a total of 37, and in the process adding jobs to our community. But we will also continue to have medical inpatient beds that will meet identified needs within our community! The culture of healthcare overall is becoming increasingly challenging. There are so many unknowns in the future, but we are committed to ensuring that we have healthcare in the community for years to come.