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DAKOTAFIRE CAFE: Discussion connects health care and community
Dr. Tom Dean shares his perspective on trends in health care at the Dakotafire Cafe. Photo by Wendy Royston

DAKOTAFIRE CAFE: Discussion connects health care and community

By Wendy Royston


Two things that are highly valued in Wessington Springs are its local health care systems and community camaraderie. And those two things go hand in hand, according to discussion at the Nov. 18 Dakotafire Cafe held there.

“Right now, in this community, our biggest shortage is not physicians. … Our biggest shortage is nursing,” said Dr. Tom Dean, a Wessington Springs physician who spoke to a crowd of roughly 35 of his friends and neighbors Nov. 18 during a Dakotafire Cafe. “We’ve had to utilize out-of-community services to bring in nurses to serve both the nursing home and the hospital, and that is very expensive, and it also interferes with continuity.”

Dean has worked with Horizon Healthcare and provided service through Avera Weskota Memorial Hospital since it opened in 1978. He was interviewed for two health care articles for the November/December edition of Dakotafire, which focused on rural health care.

Dean highlighted two other topics during his 10-minute presentation: technology and efficiency.

“(Recent technological advancements have) been mostly positive. The biggest part of technology has been the communication technology that allows us to link up with the bigger facilities,” said Dean, referencing the Avera network’s eEmergency system. “That’s probably the most important technological advancement that I’ve seen in the 35 years that I’ve been here.”

But other advancements are not all good.

“Electronic records do demand a lot of attention,” Dean said. “They help us do things more efficiently and remind us of things that sometimes get left out, but on the other hand, they clearly are still a little bit awkward, and we have a ways to go.”

Another aspect of health care that Dean said should be improved is its efficiency.

“Health care costs too much,” he said. “Whether you look at it in comparison to other countries that have better outcomes than we do; or whether you look at it in proportion to the overall economy, compared to other developed countries; or whether you look at the portion that it takes out of individual families’ budgets—(by) any of those tests, it costs too much.”

Why are the costs too high? Dean says the answer is complicated.

“There’s no one, single answer, but so much of it has to do with how we pay for care, and our current payment structures really make no distinction between high-value care and care that has lesser value.”

Dean said a system needs to be developed that rewards systems that actually provide good care in preventing and curing disease, rather than promoting a system in which some facilities perform tests and procedures mostly for the purpose of reimbursement.

Another of Dean’s concerns for the future of health care also stems from health care that sometimes is delivered unnecessarily.

“Fragmentation of care … (also known as ‘patient choice’) is a real conundrum,” Dean said. “On one hand, I think all of us believe that people should have at least some control over who they see and what care they get. On the other hand, if they bounce back and forth between one provider and another, things get missed, things get duplicated, things get lost, inappropriate things get done. The quality of care decreases, and the cost of care goes way up.”

He said the solution lies somewhere between “coordinated care” and freedom of choice.

“That is a challenge, but I think that we are making progress,” Dean said, adding that the Affordable Care Act (Obamacare) is moving health care mostly in the right direction, despite its political complications.

“These are complex issues on their own, and then when you throw in politics, they end up almost impossibly complicated,” he said. “Somehow, it would be nice—although I realize I am probably dreaming—if we could focus on just improving the care that people get, and put the politics aside. That simply isn’t reality.”

Participants went through three rounds of discussions. The top ideas harvested from these conversations are depicted below. Photos by Wendy Royston

Participants went through three rounds of discussions. Photos by Wendy Royston

Dakotafire Café conversation

Following Dean’s presentation, members of the Wessington Springs community spent about an hour addressing the shortage of health care professionals in the rural Dakotas and how to overcome that challenge using a fast-paced roundtable discussion model. The discussions centered on the factors causing the shortages, what would be possible if quality help was plentiful, and what the community can do to make health care workers feel more welcome and appreciated. Ideas from those conversations can be viewed in the photos on this page.

Following the event, the Rev. Sara Olson Dean, pastor of United Church of Christ, said the experience was beneficial to her community.

“The Dakotafire Café helped the participants to realize just how many connections there are between health care and everything else in the community,” she said. “Housing, education, amenities—these all impact our ability to attract health care providers. But it’s also true that having a strong cadre of healthcare workers can be a force for improvements in all of these areas. It is good for us to engage with our neighbors—both by listening and by speaking our own minds—and the format of the Dakotafire Café encouraged us to do just that.”

Brenda Deine, who retired after working in the education system for nearly three decades, said the format of the event is appealing to members of today’s fast-paced society.

“(They) kept the ball rolling, and got us through it,” she said. “It’s a place for everyone to get together and have a discussion and … get to know each other.”

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