people buy cabins on water and spend long weekends away from the city. I’ve seen some incredible homes along the lake. Who lives in those places?”
“Weekenders from Chicago or Milwaukee or Minneapolis.” Madge gave an airy wave of her hand. “Some fly private planes and land out at the municipal airport just east of town.”
Grace chuckled. “Such as it is. It’s a grass strip out on the Lindstrom farm, and there’s just one approach. You get a crosswind there and landing is enough to scare you right out of your girdle.”
Erin looked out the windows at a wall of pine trees. “It’s a beautiful area. There are bound to be some specialists who already vacation here—or who’d be interested in a tax write-off. They could work a day or so, a couple times a month, then have a weekend place on the lake to relax. Not to mention physicians from the Green Bay area who could come hold specialty clinics.”
“Why, when there’s not enough patients here now?” Madge snorted. “What good would that do?”
“Where do people go for an oncologist, cardiologist or allergist? How far do they need to drive?”
“An hour or more,” Grace said slowly. “But they’re already established patients in other clinics by now.”
Erin ran a finger down a column of figures on the paper in front of her. “We’ve got just five thousand residents in this town, but I figure there must be another ten thousand or more in our market area. People who could become loyal to this hospital. Who could use doctors who’d admit them here for in-patient care.”
Madge and Grace exchanged uncomfortable glances.
“What?” Erin urged, when neither of them spoke. “We’re here to discuss possibilities. Adding specialty clinics would certainly help.”
“But it probably won’t happen,” Grace said with a long, drawn-out sigh. “There’s some bad history here, over this same sort of thing.”
An oppressive weight settled into Erin’s chest as she studied the grim faces across the table. “Tell me.”
Grace fiddled with a pencil. “Ten years back, the neighboring town had a hospital like this one—both of them struggling, both competing for patients. Neither was big enough for a full-time physician on staff, so the doctors all rotated through scheduled times to be there—just like we handle things here now. Everyone wanted something better for their own community.”
“Our old administrator—the guy before George—made big promises,” Madge added. “Talked about a new lab and radiology unit, and state-of-the-art equipment. Said he was going to have a beautiful new medical clinic built next door, and talked some of the doctors into investing heavily.”
“He said he had big grants coming, too,” she scoffed. “He spent thousands and thousands of dollars on feasibility studies and planning, and even contracted some expensive remodeling projects. Most of it fell through, leaving the hospital in debt.”
“Everyone must have been upset,” Erin murmured.
“More than that. When the other hospital folded, those doctors didn’t transfer their patients here. Instead, they started referring clear over to Henderson Regional, and even some of our own doctors jumped ship. Henderson is more than fifty miles away, so our town lost trade, as well. There’s still a lot of hostility over it.”
“And George—how did he handle the situation?”
Madge’s expression softened. “He did his best. He and his wife were wonderful assets to this community.”
“He didn’t handle it,” Grace said shortly. “Not well. George was good with the staff. He was honest and caring. But he didn’t like controversy and preferred smoothing ruffled feathers to taking an assertive stance.”
Erin stifled a sigh. “So you don’t think it’s possible to lure specialists here.”
“You know what it’s like at state nursing or medical conventions. People talk, word spreads. I’d say it would take a miracle.”
Erin shuffled through her papers, withdrew a summary of the financial status of the hospital that had been presented to the board last year, and pushed it across the table. “I know you’ve both seen this before, but this is the past. The future has to bring change, or we’re looking at significant layoffs within the next six months.”
Madge stiffened. “George never—”
“The hospital has been running at eight full-time equivalents per occupied bed.” At the look of confusion in the woman’s eyes, Erin added, “That’s like saying we have eight full-time employees per patient, when you add full- and part-time staff. That’s almost twice what the ratio should be, and we also have a high number of empty beds.”
“But the patient care we give is excellent!”
“Maybe so, but that level of revenue per employee just isn’t feasible if we’re to operate in the black,” Erin said firmly. “Still, if we can offer more services, build our market share and reduce staffing through attrition rather than layoffs, I know we can turn this place around.”
At the word layoffs, Madge blanched.
“I need support—from the doctors, the community and especially the staff. Anyone not willing to change will need to think about whether or not they still belong here.”
After a long pause, Grace’s eyes twinkled. “I do believe you can do it.” She gave Madge a nudge. “Right?”
Madge swallowed hard. “I need my job. So do my niece and my brother-in-law, and all the other people who work here. I…guess we’ll have to do what it takes.”
Erin stood and shook Grace’s hand, then Madge’s. She watched pensively as they left her office.
It was a lukewarm response, but it was a start.
CHAPTER FOUR
BY THE TIME SHE GOT the kids ready for school and dropped them off at George Washington Elementary, Erin was ready for a strong cup of coffee and a few minutes’ peace.
Lily had burst into tears over a missing homework assignment. Tyler hadn’t been able to find his shoes or his baseball mitt. And Drew had announced that his teacher was dumb, school was a waste of time and he wasn’t going back.
Not for the first time, she thought grimly about her ex-husband, who’d chosen to cavort with some pretty thing half his age rather than face the responsibilities he’d chosen when he and Erin had decided to adopt.
Single parenting was a challenge she hadn’t expected, though given the choice of being married to Sam or having these children, she knew she’d gotten the far better deal.
At the single-story brick hospital, Erin walked through the wide front doors and greeted Beth, the receptionist, who was sitting at the desk in the lobby. Past the open double doors to the left, the west wing housed a nurses’ station, thirty long-term care beds and five beds designated for skilled care. The recreation and dining rooms were at the far end.
She waved to several patients in wheelchairs who were out in the hall, then continued straight ahead to the north wing, which housed her office, the other administrative areas, the main pharmacy and several infrequently used surgical suites.
From the first moment she’d stepped inside, she’d loved this place, with its big, old-fashioned windows and small-town atmosphere. It was a microcosm of a big city hospital, really—offering many of the same services, but on a much smaller scale.
At the sound of a shrill alarm, she spun around and hurried through the lobby to the east-wing nurses’ station, which served the single, long corridor of hospital in-patient rooms. A few patients peered into the empty hallway from their doorways, then disappeared. At the end of the corridor, the double doors into the emergency department remained closed.
Surprised, Erin