For Arkansas Children’s, the impetus for growth is about more than physical expansion — it’s about reaching children who need healthcare in a rural and sparsely populated state.
The two-hospital, Little Rock-based system is expanding access through $371 million in construction projects — from expanding outpatient surgery, sports medicine and a pediatric clinical research unit at Arkansas Children’s Hospital in Little Rock to building the National Center on Opioid Research and Clinical Effectiveness, soon to break ground adjacent to the Arkansas Children’s Research Institute.
“Five years ago, when we put that plan [that launched the projects] in front of our board, that was the very first month of the pandemic, where so many healthcare systems were almost paralyzed by the challenge of living in a pandemic and leading in a pandemic,” Marcy Doderer, president and CEO of Arkansas Children’s, told Becker’s. “And we found the kind of internal strength and the need to put forth a strategic plan that has paid off in spades for us.”
Now, as the health system prepares to launch a new five-year strategic plan in July, Ms. Doderer reflected on the success to date and how the organization is structuring expansion efforts to meet both short-term and long-term care needs.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Arkansas Children’s is investing significantly in systemwide expansion — how are you structuring these efforts to ensure they don’t just meet today’s demand, but strategically prevent access bottlenecks five or 10 years from now, particularly in rural or underserved areas?
Marcy Doderer: I get challenged sometimes by people in and outside our industry about how to even have the courage to grow, given all that’s happening in our world. And it’s really our five-year journey we’ve been on that has fueled this growth and will set us up for a better future — and actually more growth.
Five years ago, when we launched a strategic plan in 2020, we set an aspirational goal of being within 60 miles of every child in Arkansas. And as we sit here today, we have not achieved that goal, but we can effectively say 86% of all children in Arkansas are within 60 miles of Arkansas Children’s at one of our physical locations, and many much closer than that. And many have an opportunity to also access via telehealth.
And while that number may seem insignificant if you live in a major metropolitan area, I think the numbers that speak to Arkansas are actually important in this story. The state of Arkansas has about 3.1 million people. We’re No. 33 out of 50 in population size, but we cover over 53,000 square miles — so we’re 29th out of 50 in geography. Of those 3.1 million people, over 800,000 are aged zero to 21. If you think of 800,000 people spread across 53,000 square miles — not evenly distributed, as you might imagine — it’s hard to get within 60 miles of any one of them. But that continues to be our aim.
To do that, we must think about our physical spaces, as well as virtual options. Today, we operate two hospitals that are 190 miles apart to capture the bulk of those families. Again, I think our approach at Arkansas Children’s is harder and does take more courage in the growth space than others, because I can think of my colleagues and friends in cities like San Antonio or Dallas-Fort Worth, Chicago, Philadelphia — they’ve got 2 million kids in their backyard,— not 800,000 spread across 53,000 square miles. So, the geography and the goal to be closer to kids is what’s really driving this growth. And we have to be able to do it differently than others.
Five years ago, when we launched this strategic plan, we saw about 142,000 to 143,000 unique patients — hundreds of thousands of encounters — but 142,000 unique children. As I head towards the close of my fiscal year, which we will close out on June 30, we will be somewhere north of 195,000 unique children. So in just five years, we’re touching more than 50,000 more children per year than we were doing five years ago. There’s the impetus for this growth.
Q: As part of the $371 million investment, how are you balancing the need for scalable, physical infrastructure with community-based outreach and digital tools to create a pediatric care model that’s both accessible and sustainable long term?
MD: It is much more of an art than a science for health systems like ours to figure that out. Not every child has the ability to travel. Travel is inconvenient for everyone and certainly impossible for some. And when we think about how many of our children have to travel more than 200 miles to reach a hospital, it can be a problem. So we’re very purposeful in understanding the kinds of care that require face-to-face, elbow-to-elbow intervention with a child — seeing quaternary care, neonatology, cardiology and heart transplant, nephrology, and for the high-acuity issues, trauma — versus what could be the best and simplest digital solution for kids with more chronic illnesses.
Think about a Type 1 diabetic who might only need to be seen by the endocrinologist once or twice a year, but absolutely needs quarterly check-ins, quarterly review of their lab results, that kind of thing. So our answer to physical growth for us is focusing bricks and mortar on the things where we believe kids really must be seen in person, and building out the platform that’s very consumer-facing to help kids stay local — in their small community and in their home community — and get those easy lab, easy imaging results that connect back to the children’s experts virtually.
And that’s culturally not easy. Physicians and providers who’ve spent a lifetime learning how to treat a child in person don’t naturally transition easily to a virtual environment. And so it takes a while. The technology makes it easy — the culture doesn’t always. And so it can be a harder lift depending on your own patient or provider population.
Q: Is there anything else about Arkansas Children’s expansion efforts that might be helpful for other hospital executives to hear — particularly given today’s challenging environment? What do you think has propelled the organization forward despite these obstacles, and have there been any surprises along the way?
MD: As we’ve focused on growth, more patients every day — we’ve also really concentrated on recruitment and retention strategies to shore up our workforce and to be seen as a strong economic driver in a state like Arkansas. In the five-year time frame of our last strategic plan, we had a 140% increase in job applicants every year, year over year. We see maybe 20,000 to 22,000 applicants in our health system in a year. We’re closing out a fiscal year with over 52,000 applicants for our job positions.
If you drop that down one level to nursing, five years ago, we might have had 3,000 to 3,200 nursing applicants. We’re going to have almost 5,300 nursing applicants this year. Our applicant rate is now 40 applicants for every one position. That’s a heavy recruitment, talent acquisition strategy that is really working for us.
I would also say retention is critical. Our overall turnover rate of the health system is now down to 14%. And then lastly, thinking about — in that turnover — reducing that turnover came with high employee engagement. We use the Glint survey instrument for employee engagement. We’re one point away from being in the top decile of employee engagement on Glint, and that’s our target for this calendar year.
