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When he moved from another system to take over the top post at Avera Health, Jim Dover says his first priority was "seeking to understand" the system.

He sees the biggest mistake a leader who's new to an organization can make to be assuming to know the place well right away. "In reality, they don't know anything," says Dover, who became president and CEO of Avera Health in fall 2023.

Dover says he took his time to acquaint himself with operations at the Sioux Falls, South Dakota-based system. Avera serves four states and has 20,000 employees, a 1,200-member medical group, 37 hospitals, 200 clinics and 40 long-term care facilities.

"This year is its 25th anniversary," Dover notes. "So, first and foremost, I wanted to understand the organization and its culture."

Once he was familiar with Avera, Dover oversaw a 10-month process to develop a new strategic plan. The process involved input from 200 stakeholders from within the system and from its partner organizations. In December, Avera's board approved the plan.

The strategic plan is the third for the system. The first one was called "Ignite" and the second, "Reignite." This one is called "Illuminate." Dover says that name reflects the aspirations of Avera to bring light through its care in the same metaphorical way that in the Bible God's presence and goodness is often represented as light.

The plan has five pillars:

• Exceptional patient, employee and community experience
• Dynamic physician and provider enterprise
• Innovative care models across the continuum
• Broaden geographic reach
• Leadership and essentiality in all the communities the system serves

Under the pillars are 102 initiatives that Avera will focus on for the next three years. Some initiatives are already underway, such as more than $300 million in capital projects in the Sioux Falls market and moving all health records over to the Epic electronic system.

"I feel we have the highest probability of success because this wasn't a plan that was developed at the senior suite," Dover says. "It was really written by our organization and so everybody owns the success of the plan."

Return to Catholic health care
Dover has four decades of experience in health care leadership. From 2019 until his move to Avera, he was in the top post at the secular Sparrow Health System, which is based in Lansing, Michigan and in April 2023 became part of University of Michigan Health. Before that, he worked at several Catholic systems. His previous positions include leadership roles at systems sponsored by the Sisters of Providence, Sisters of Mercy, Daughters of Charity, Sisters of St. Joseph of Carondelet and Hospital Sisters.

"When I was ready to exit Sparrow after putting the affiliation together with University of Michigan Health, the Avera opportunity came up and I always kind of feel like providence has a hand in it," Dover says. "It's great to be back in Catholic health care."

Dover says the workforce challenges that health systems have faced since the COVID-19 pandemic persist, but Avera is seeing its retention rate rise and its turnover rate drop.

He considers the system's Catholic mission to one of its attractions for staff. "When we say that we're a health ministry rooted in the gospel and our mission is to make a positive impact in the lives and health of the people in the communities we serve, we are absolutely serious about it," Dover says. "We are, what I would say, authentically living our core values and our Catholic values and that culture attracts people to our organization."

Workforce development
Even so, Avera is putting programs into place to train and keep workers, especially in positions that remain hard to fill. One such program is Avera Nursing Advantage, a partnership with South Dakota's Mount Marty University announced last fall. Nursing students at the Catholic university will be eligible for $30,000 scholarships in their last two years. In return, they commit to working for Avera for three years.

Dover notes that unlike systems in warmer states such as Florida, Avera has a hard time attracting nurses to the upper Midwestern region it serves. "We really are working very hard to grow the nursing cohort locally, because we know we have the highest probability of them staying for a long time," he says.

Another challenge Avera is mindful of is keeping its rural hospitals, which is to say most of its hospitals, healthy. To do that, Dover says the system is following best practices around keeping care local. Among those practices is partnering with various clinics and with cohorts of physicians who are willing to care for patients in rural areas. To support those doctors, Avera provides patient transportation and telehealth services.

Another best practice is to keep hospital governance local, Dover says. He notes that many systems that operate rural hospitals have opted to have centralized boards and leadership teams. That loss of local control, he says, leaves patients feeling less connected to their local hospital and more likely to look elsewhere for care.

"I think if you were to do the study, results would show that when you lose that local community stickiness, that all of a sudden out-migration (by patients) becomes really easy," Dover says.

Keeping an eye on D.C.
Even as Avera keeps its focus local, Dover acknowledges the system is well aware that decisions being made in Washington could affect its operations. For example, the cuts under discussion for Medicaid would affect many of Avera's patients. He used CHA's resources from its Medicaid Makes It Possible initiative to share some statistics for South Dakota. For example, across the state, 13% of the population is covered by Medicaid or the Children's Health Insurance Program, including two of every seven children.

"These drastic cuts that are being proposed are going to have a very real impact on us and on access," Dover says.

Another potential change in federal policy that could present challenges for Avera would be if coverage of telehealth services that was approved during the pandemic ended. As of now, that expansion is set to lapse at the end of March.

Dover says it would be "incredibly shortsighted" to end the coverage expansion. But even if that happens, he says Avera won't give up on remote care. "We've found it to be an effective tool that keeps care local," he says.

The system also is solid in its long-established commitment to mental and behavioral health care. He notes that the system recently added 16 beds to the Helmsley Behavioral Health Center, which opened in Sioux Falls in 2022.

He says many systems have backed away from mental health care. "It's really hard work," Dover says. "Funding can be really challenging. Some states are not very supportive."

Dover says Avera has been fortunate in that the states it serves have been helpful. For example, he says South Dakota has worked with the system to keep mental health care local and to ensure that best practices are followed.

"We've had a very supportive state, and that has been helpful," he adds. "We have gracious benefactors, and we enhance our learnings to stay really good at it."

Off-hours interests
When he's not in the office, Dover engages in what he calls his lifelong passion for tennis. He hits the courts twice a week. He and his wife have four adult children, who are split between the East and West coasts, and a grandson.

In addition to visiting family, the couple like to travel the world. They are determined to visit every continent and have so far made it to five. One of the remaining two, which he hopes to visit before he retires, will require a potentially bumpy flight.

"I'm dreading crossing the Drake Passage to get to Antarctica," Dover says. "I have severe motion sickness, so I've got to prepare myself for that one."