Shaping the Future of Rural Healthcare at Avera

James Dover, President & CEO of Avera Health

By Alex Strauss

This past fall, James "Jim" Dover left his position at the helm of a large Michigan health system to become the third President and CEO of Avera Health, one of the largest not-for-profit rural healthcare systems in the Midwest and one of the "big three" in South Dakota. Avera's footprint includes locations in five states and the health system employs more than 20,000 people at its 37 hospitals, 200 clinics, and 40 long-term care facilities. 

What drew the California native to Avera and to the Sioux Falls community? What impressions does he have after his first few months? And what are his hopes for Avera Health in the years ahead? With so many of MED's readers depending on the "health" of Avera, we sat down with Dover to find out. 

MED: Had you been to Sioux Falls before you moved here? What do you think of our community?

JD: My family and I drove through the state years ago [Note: Dover is a father of four] and we stopped at The Falls. But this is the first time I've been embedded in the community. 

Sioux Falls will be the largest small town I'll ever live in. Before I moved here, I went to a restaurant and I was chatting with the waitress there and found out that she works at Avera. Everyone here either works at Avera or has been treated at an Avera facility or has a friend or relative who works here. 

It's also a community whereby the mayor, city council, and the local business community all work together for the benefit of the entire community. In Sioux Falls, it's clear that these entities get together and hash out what they're going to get done. You can tell that this is happening when you look at the coordinated growth. And that is really refreshing. 

And I love that they let you drive 80 miles an hour on the interstate.

MED: What drew you to Avera Health?

JD: First and foremost is the Mission. Avera is an authentic Catholic health ministry to both urban and rural areas and the Benedictine and Presentation sisters live that out every day. And it was clear that our providers, leaders, and governance are all centered around the mission, too. I feel like work that is not mission-driven leaves you wanting at the end of the day. 

The second thing that impressed me was the professional opportunity. At Avera, I am able to practice at the top of my license. At an organization like ours, a leader wants to be able to lead in a full manner and not be limited. It has been a pleasure to lead from that standpoint. 

The third thing that really drew me to Avera was the chance to be a part of their growth. Sometimes, as a leader, you come into a turnaround situation where an organization is in decline. And there is satisfaction in that. But to join an organization in such a positive position is always very attractive to a health system leader.

MED: What have you noticed in your first 90 days that you wouldn't necessarily have seen from the outside? 

JD: A lot of people associate Avera Health with rural healthcare. But we are also a large, integrated health system. In South Dakota alone, our annual payroll is a billion dollars. That is pretty big. And we have a research institute doing research that is so important that the federal government gave us 58 million dollars just last year. 

But we are not flashy or self-promoting. I don't find a lot of braggadocious people here. We are proof that you can value kindness and hospitality and still be efficient and competitive. 

And, of course, I've noticed the incredible competency of our people. The level of clinical expertise here is remarkable. These are highly trained providers, nurses, staff and leaders. People trained at the Mayo Clinic, the University of Iowa, and other top-ranked institutions. Our nurses are coming out of top notch programs. They are very well-trained but very understated. 

MED: What is ahead for Avera in the next few years?

JD: I expect us to make some pretty significant capital investments after a pause over the last few years. The market is growing, as is our market share. We are getting to the point where we are reaching maximum capacity, especially in Sioux Falls. We need to build for the future, so we never have to turn a patient away. 

We'll also be making clinical investments to support the continued growth of our oncology, heart and orthopedics programs. And we expect to add another 120 physicians and advanced practice providers over the next five years to expand our clinical footprint. 

MED: What do you see as the biggest challenges for the health system right now?

JD: There are the normal environmental hurdles. We have a congress that is locked up and can't get things passed. Meanwhile, our industry is heavily regulated. 

Workforce is also a big issue. How can we support our academic institutions to produce more nurses? I've already started to have conversations with Southeast Technical Institute, Mount Marty University, and others to figure out how we can work together to do that.

I also worry about the rising costs of medical supplies and pharmaceuticals. If these costs are growing at six percent a year and reimbursements are only growing at one percent, that's going to be a bigger and bigger challenge. 

MED: How do you see Avera contributing to the bigger picture of healthcare going forward?

JD: One big opportunity is through research. Research shouldn't be limited to academic institutions. We see 50,000 inpatients a year. We have over 2 million clinic visits and over a million ambulatory encounters. Today alone, there will be 3,000 primary care visits across our footprint. 

We need to be able to use that data to help advance medical research. We have a responsibility to improve the health of all of the communities that we serve. I see this advancing in the future.