Taking care of the diabetes-related infection that destroyed a large part of Steve Schultz's big toe was quick and relatively easy. The time it would take for the wound created by the infection to heal was a different matter, however.

To speed up that process, Steve's doctor suggested that he go for a "dive."

A "dive" is the term used by doctors and nurses to refer to a treatment in a hyperbaric chamber. This therapy involves bringing the patient to 2.4 Atmospheres Absolute, the equivalent to 47 feet under water, for 90 minutes. While pressurized, the patient breathes pure oxygen, which saturates the plasma in the blood and improves several factors in the healing process.

Schultz regained mobility and return to work much sooner than if the wound, which was created by a lack of blood flow in the first place, had healed on its own. Ashland Community Hospital's Center for Wound Healing and Hyperbaric Medicine, affored Schultz the treatment without traveling to McMinnville or Chico, Calif. &

the next closest hyperbaric treatment centers. The time and costs of travel and missed work would have made the multi-treatment process unaffordable if not right in his own backyard.

Hyperbaric medicine has many applications, the most widely known is its use as treatment for decompression sickness or "the bends." But the facility in Ashland most commonly utilizes the technology for three indications: diabetic wounds of the lower extremities, radiation damage &

generally from cancer treatment &

and bone infections.

Each of these illnesses require many "dives," &

40 in Schultz's case &

which means the patients must remain close to the treatment center. For Rogue Valley residents who, because of head and neck cancer treatment, have lost blood flow to their jaw and must have their teeth replaced, the course was especially difficult before the center in Ashland opened.

"The oral surgery patients used to have to go up to [McMinnville], rent an apartment for four to six weeks, go through the treatment, return here for their surgery, and return to [McMinnville] for the last two weeks of treatment," explains Karen Adams, wound ostomy nurse and program director of the center.

Local benefit

"It's a real asset to this community to be able to keep people where they live," Adams says. "They get to maintain their lifestyle, they get to stay at home, they get to keep working and they get the treatments."

Part of what has made Ashland Community Hospital successful over the course of the last century is this careful balance of technological improvement and care for the local community.

While the purchase of a CT scanner and fluoroscopy unit in 2005 benefits both patients and doctors by providing diagnostic and imaging services that were formerly only available in Medford, the hospital also introduced its Hospice and Palliative Care program in the same year &

a service that directly benefits the community by addressing the issues of an aging population.

Improvements such as these are possible through a combination of the hospital's board of directors &

whose philosophy includes setting substantial amounts of budget money aside for updates to current technology &

and the Ashland Community Hospital Foundation, a non-profit corporation that raises and grants funds for the hospital in addition to promoting community health outreach in Ashland and Talent.

Raising funds

The foundation essentially asks the hospital's board how it can help lessen the weight of the budget each year by contributing to priority projects. Don Mackin, president of the ACH foundation's board of directors, says that over the past five years equipment has been the focus of fundraising efforts but that they have now shifted their efforts towards relocating the Memory Care Center, formally called the Trinity Respite Center.

"We have two main fundraising programs: a patron's campaign in the spring and the 'Lights for Life' campaign during the holidays," he says. "If there is a specific piece of equipment that the hospital needs, that becomes the focus. This past year the hospital indicated that the relocation of the Memory Care Center had become a priority so we're in the process of finding a piece of property and coming up with a remodeling plan."

This system of financing has made it possible for ACH to build both a new Diagnostic and Surgery Center and a two-story business office building within the last few years. Still, finances remain an issue. Both Mackin and Mark Marchetti, the hospital's chief executive officer, agree that the biggest challenges going forward for all small hospitals are the decline of Medicare/ Medicaid reimbursements and the growing number of uninsured patients.

"Small hospitals lack the 'economy of scale' that large hospitals have," says Marchetti. "I think all hospitals struggle with how to be more efficient, how to be more productive and how to control costs, but in reality ... reimbursements from most of the major government funding agencies fail to cover the actual cost of treating a patient."

Marchetti says that, because of these obstacles, hospitals are increasingly reliant on contributed support and views the relationship between the hospital and its foundation as a way to create a "robust culture of philanthropy" that would help support the hospital in the future.

Competitive advantage

Another approach that the hospital has taken is to identify areas where reducing competition could result in decreased cost for both patients and providers. The nonprofit corporation Siskiyou Imaging is a partnership between Ashland Community Hospital, Rogue Valley Medical Center and Southern Oregon Radiology Associates that reinvests all profits back into the community.

The center brings advanced imaging technology in the form of a magnetic resonance imaging machine that would normally only be available through a private company, but through cooperation benefits every patient and doctor in the area.

While technological services are important to both attracting patients to the hospital and serving them once they are there, the experience of the patient is determined by the attitudes of the institution responsible for their care. To this end, the ACH board of directors approved affiliation with Planetree in 2006.

The Planetree Organization will help the hospital to develop a patient-centered &

as opposed to provider-centered &

approach to medicine. This method incorporates nutrition, spirituality, complimentary medicine and patient education to create a more hospitable environment for patients and their families.

Anne Golden, a director on the ACH board, is certain that the future of the hospital ultimately depends on the same component that has made it successful in the past.

"It's the people!" she says. "It's the leadership and the staff of the hospital that really are clear about the mission and the continued focus to deliver high quality patient-centered care. It's the community members who give us feedback. The best way for us to sustain ourselves as a healthy, quality organization is to foster the environment for feedback going both ways."

can be reached at graysonberry@gmail.com