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MMHC Capstone Tackles Disparities in Rural Healthcare Systems

Jan 3, 2023
Students aim to increase surgical volume in rural healthcare systems

By Arial Starks

(Left to right) Dr. Travis Hamilton, Tyler Sansom, Lynn Welker, and Dr. Hank Lemley

Critical access hospitals (CAHs) are small healthcare facilities with fewer than 25 beds. They provide limited outpatient and inpatient hospital services to people in rural areas. To operate profitably and maintain financial solvency with a manageable debt burden, CAHs must be resourceful and creative, which is challenging with limited resources. Services that are important to the fabric of rural communities, like labor and delivery, are not typically revenue generators. The challenge of working to offer important and necessary services while also realizing a profit margin, sparked a Capstone Project idea for Vanderbilt Business Master of Management in Health Care candidates Lynn Welker, Tyler Sansom, Travis Hamilton, and Hank Lemley.

“We connected with McKenzie County Healthcare Systems (MCHS) in Watford City, North Dakota, a client that I work with,” said Welker. “I have a passion for rural healthcare systems, and Tyler, Travis, and Hank all have meaningful experience in different complementary areas, so I thought, ‘hey, what a cool dynamic if we could bring this together to tackle a problem, here, in the middle of nowhere.”


While looking into different challenges rural hospitals face, Welker reached out to Michael Curtis, the former CEO of MCHS. The hospital was working to deploy labor and delivery services in the near future. Curtis let Welker know the new services, which hadn’t been available for more than 25 years at MCHS, would be expensive. This sparked the group’s capstone project idea: increasing orthopedic surgical volume in a rural frontier.

The group proposed the idea of the hospital performing more orthopedic surgeries in order to bring in additional revenue, offsetting the expense of the labor and delivery services the hospital was planning to deploy.

“Based on the location of the healthcare facility, our team was afforded a unique opportunity to think out-of-the-box,” Welker said. “MCHS has an amazingly talented orthopedic surgeon in Dr. Joshi. How do we effectively offer his skill set to new patients in neighboring, international markets – in this case, Canada?”


The group decided in order for MCHS to significantly increase its orthopedic surgeries within the hospital, distinguished orthopedic surgeons like Dr. Ravindra Joshi, MD, with enhanced operating room utilization, could perform more surgeries for an untapped patient market seeking quality of life procedures, like hip, knee, and shoulder replacements.

While searching for areas that could benefit from more orthopedic surgeries, the team discovered that right over the North Dakota border, Canadians were suffering from an orthopedic surgery backlog. Due to a shortage of surgeons and hospital staffing in Canadian healthcare facilities, the list of patients needing a hip, knee, or shoulder surgery was only growing.

“You have people that have been cleared for orthopedic surgery, but they can’t get scheduled for a procedure,” said Hank Lemley. “What we calculated at one point was around a 72-week wait time.”

The team considered many marketing strategies for this project, mainly focusing on targeted and digital marketing. Since the group found a number of Canadians suffering from bone, joint, and muscle issues were winter sports enthusiasts, the group proposed marketing around ski areas and resorts. Market research also revealed that digital marketing could be an effective channel. The team’s recommendations included digital advertising for orthopedic surgical procedures, along with a website offering price transparency.

The group presented their recommendations to Curtis virtually to conclude the project.

“I felt like it was very educational to learn how our neighbors in Canada best receive information,” said Welker. “We wanted to learn what our target market for orthopedic surgery was and at what point would an individual choose to drive to North Dakota for that surgery. So I really enjoyed and appreciated the work that we did to understand our neighbors to the north, and what strategies would be most effective if deployed.”

“I think the biggest thing it taught me was to think creatively when solving a healthcare problem,” said Tyler Sansom. “You can’t just look at it as a black and white situation. You have to put on an innovative lens and look across the broader industry for solutions.”

To learn more about how the Vanderbilt Business Capstone Project prepares MMHC students to tackle challenges in the healthcare industry, click here.

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