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Small Hospital, Big Results: Systems Thinking In Rural Michigan

For our second article exploring innovative clinical sites and new models of care delivery, we recently traveled to Harbor Beach Community Hospital located in Harbor Beach, Michigan.

This facility is a Critical Access Hospital in a summer resort community in Michigan’s thumb. Harbor Beach is a small community of only 1,700 people. Often, small size requires more innovative thinking.

Led by CEO Ed Gamache, this organization embraced big-changes through systems thinking. Their efforts have been recognized by the National Rural Health Association (NRHA) as a Top 20 Critical Access Hospital.

The Harbor Beach team’s innovative process improvements are guided by Dr. John Kenagy and Adaptive Design®. Adaptive Design® is an integrated set of methods, skills, and tools that make everyone accountable for patient-centered innovation as part of their everyday work. This system design approach empowers individuals to enact change by giving everyone quality improvement capabilities and responsibilities.

By using this system, employees more quickly discover and solve problems that could contribute to errors and patient outcomes that are less than ideal.

For example, providers use an EKG machine with chest-pain patients in the emergency department. The machine stopped functioning recently, leaving a patient and the provider in a difficult situation. Thanks in part to Adaptive Design® implementation, Harbor Beach staff recognized the machine’s memory limit cannot exceed 300 readings. Missing was a standard procedure to prevent or deal with this problem, contributing to reduced patient care.

By empowering employees who worked with the EKG machine, they collectively developed written documentation and standard procedures to ensure the machine’s memory is actively managed.

This initial success is catalyzing other process improvements across the organization that the Harbor Beach team is addressing at an appropriate pace to ensure every patient and family receives high quality care.

Approaching quality and process improvement demands big thinking—not necessarily big budgets or big staff.



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