Amy Lee has served as president of Nantucket (Mass.) Cottage Hospital, part of Somerville, Mass.-based Mass General Brigham, since October 2022. She leads a hospital where dramatic seasonal shifts in population affect everything from staffing and housing to capacity and care coordination.
Those experiences have also given Ms. Lee a window into challenges facing other seasonal, rural and remote hospitals. She told Becker’s there is an opportunity for these organizations to learn from one another, whether around workforce strategies, patient transfers or maintaining access to care with limited resources.
That thinking is behind the first Nantucket Summit, which the hospital will host Oct. 7-9. Ms. Lee expects leaders from about 40 hospitals to attend, with discussions spanning workforce and housing, capacity, care access, emergency preparedness and other issues facing seasonal and remote communities.
In a recent conversation with Becker’s, Ms. Lee discussed what Nantucket Cottage has learned from operating on an island, what other hospitals might take from those experiences and where she sees opportunities for greater collaboration.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Nantucket’s population changes dramatically during peak season. How does that volatility affect decisions around staffing, capacity and capital investment, when the hospital has to be prepared for demand that may exist only part of the year?
Amy Lee: We have to be prepared for a wide range of demand all year. Even in the winter, when the population is much smaller, we still need the staffing, training, and infrastructure to support services like labor and delivery and emergency care.
In the summer, we scale up with seasonal staff, many of whom return year after year. That continuity is incredibly valuable because they understand the hospital, the island, and the pace of the season.
The challenge is that we are 30 miles at sea and do not have every resource immediately available. That means preparation matters. We invest heavily in simulation and ongoing training so our staff are ready for situations they may not see every day.
We also build capacity within the community. Local paramedics train in our ED, and our School-to-Career program introduces students to nursing, pharmacy, physical therapy, facilities, and other hospital roles. For us, staffing and capital decisions are really about making sure we have the people, skills, and infrastructure in place to respond whenever the need arises.
Q: Have housing costs changed how you recruit, retain or structure your workforce?
Amy Lee: Housing is a huge part of how we retain and recruit, and we intentionally say retain first because keeping great people is our priority. Nantucket is one of the most expensive places in the country to buy a home, and that affects employees at every income level, from entry-level staff to physicians. Even for our highest earners, homeownership can be a real challenge.
That means we have to be creative. We have a full-time housing coordinator whose job is to work with staff to identify solutions and make sure they understand all of the options available to them. Those can range from hospital housing and rentals to housing lotteries, Habitat for Humanity, Rooted Rentals and Lease to Locals. A big part of the work is simply helping people navigate what is available and find the option that works best for them.
When I first came here, we offered 90 days of housing, and we learned quickly that was not enough. We now provide significantly more support because there is no one-size-fits-all solution. We also make sure people understand what it means to live on an island before they come. Housing is expensive, everyday amenities are more limited, and island life requires a different level of planning. Setting those expectations early is important.
As an organization, we own close to 40 homes, and we are in the middle of a capital campaign to build 48 additional units. We think about housing in terms of beds: How many do we have? How many do we need? Where do we need flexibility or emergency housing? Ultimately, housing is a critical part of making sure we can keep the people who make healthcare on Nantucket possible.
Q: What can leaders at larger urban systems learn from how seasonal and destination hospitals handle transfers, supply chains and access to specialty and emergency care?
Amy Lee: One of our most successful programs is called seasonal care coordination. What that means is that we have a department whose full-time job, all day every day, is making sure that patients on island or who are coming on island who may be medically complex or without a PCP, can get the care they need. Most of the time, they will transfer that care back to someplace else, so this program provides continuity of care for the patient and family.
Many of our patients come to Nantucket for the summer, for work, or for an extended stay. While they are here, our job is to provide the best possible care while staying connected with their providers at home. That communication is a two-way street. Sometimes it is as simple as coordinating follow-up after an emergency visit before a patient leaves the island. Other times, it is much more complex, such as arranging chemotherapy infusions for someone who will be here for several months. Whatever the situation, our seasonal care coordination team works directly with the patient’s existing care team to make sure there is continuity and that the patient receives the care they need while they are on Nantucket.
That’s led to some great relationships, and for our staff it leads to a lot of comfort. They have resources not just from wherever that patient’s coming from. We also have a superpower with Mass General Brigham as our partner, so for those really medically complex patients, it gives us even greater ability to take care of patients.
One of the statistics I’m really proud of is that we only transfer 3% of patients off island to a higher level of care. Through our talented clinicians and telehealth we can take care of 97% of the patients who come here.
Q: What does that capacity look like day to day?
Amy Lee: For the 3 percent of patients who need a higher level of care, we have the ability to transfer them to Mass General Brigham or wherever they need to go. But what makes that possible is the strength of the team we have here. We work hard to retain and recruit talented people who want to be part of this community, and many of our seasonal and traveling staff ultimately choose to stay because they value the culture and what we are able to accomplish.
Our primary care and specialty teams also add an important level of care that allows patients to manage more of their healthcare here on Nantucket. That access is essential to making it possible for people, especially our year-round community, to live on the island while still receiving the care they need.
We also focus heavily on access and patient flow. Even during peak season, the average time to see a provider in our Emergency Department is less than 15 minutes, and in our Urgent Access Walk-In Clinic it is less than 10 minutes, even when we are seeing 100 to 120 patients a day. That comes down to strong processes, teamwork and a real sense of ownership. We keep the patient at the center and continually ask what we can do to make sure they receive the best possible care, as close to home as possible.
Q: You’re bringing leaders from rural, island and destination hospitals together for this summit. Where do you see the greatest opportunity for these hospitals to work together, and what could a national network accomplish that individual organizations can’t on their own?
Amy Lee: The goal of the summit was to bring together hospitals that face the same kinds of challenges we do. There are roughly 300 hospitals like ours, and if we can share ideas and resources, there is a lot we can accomplish without reinventing the wheel.
Even in planning the summit, we have already learned from conversations about continuity of care, emergency management and staffing. Some of those ideas are things we can put into practice right away.
There are also real opportunities to work together. Our peak season is the opposite of many mountain communities in places like Colorado and California, so could we share seasonal staff? Could we learn from one another about emergency preparedness or patient coordination? The real value is building relationships with leaders who understand these challenges at the same scale. That gives us a network we can turn to, learn from and collaborate with.
Q: Have any official partnerships or collaborations come out of organizing the summit?
Amy Lee: For Nantucket, one of the biggest opportunities has been strengthening relationships with hospitals that share patients with us. Many people spend part of the year here and part of the year somewhere else, so the question is: how do we make that transition as seamless as possible? The summit has helped us connect directly with hospital and clinical leaders, identify the right contacts, and create clearer pathways for sharing information and coordinating care.
Our seasonal care coordination program is a great example. If we know in advance that a patient coming to Nantucket will need chemotherapy or another ongoing treatment, we can work with their home facility before they arrive and have everything coordinated. That takes a significant burden off the patient and both care teams. Ultimately, it is about making sure the patient experiences one continuous care journey, even when that care is happening in different places.
At Becker's 4th Annual CEO + CFO Roundtable, taking place November 2–5 in Chicago, more than 1,500 hospital and health system executives tackle decisions that determine whether organizations thrive or merely survive: protecting margins under cost pressure, choosing where to grow, renegotiating payer relationships, stabilizing the workforce and proving real ROI on technology. This is where leaders work through them together, face-to-face. Apply for complimentary registration now.
