In all, ORHC and its parent company LifePoint Health, have invested $4 million in capital upgrades, plus $1.1 million in salary increases for nurses in the last twoyears, plus other salary increases totaling another $1.5 million.

"We continue to invest in the organization and into our people to bring the very best in, so that they then provide the very best care to our patients," Kiefer said. "We will continue to evaluate this moving forward and continue to work to maintain our competitive nature and competitive stance when it comes to salaries in the market."

The hospital's efforts to improve haven't stopped and won't stop, Kiefer said. He acknowledged frustrations with billing and the emergency department continue, but the hospital continues to chip away at those, too.

Medical billing is complex for everyone involved, but Kiefer said those with struggles can always phone the hospital directly to receive help locally to address their concerns.

While some wait in the emergency department may be unavoidable at times because the hospital draws emergency patients from a larger region and in some cases other area hospitals, Kiefer said lives are saved every day.

"If you come with an acute (emergency) situation, we are going to triage you appropriately, and we're going to take care of you," Kiefer said. "We will save your life in our emergency department, we do it every single day."

The reality also exists that some situations are beyond what ORHC is staffed and equipped to handle. And for those, there will always be transports to larger facilities in Des Moines and Iowa City.

"I know that people have feelings about the helicopter," he said. "We are that middle-tier hospital. We have smaller regional hospitals that surround us, then there's us as a step up, and then there's the tertiary facilities in Des Moines and Iowa City.

"We will never be a tertiary center of care. We will never do cardiac open heart surgery. We will never do complex neuroradiological work. That is not what we're meant for. We don't have the population to support that type of provider in the community where we live."

But even still, the hospital is working to continue improvement in terms of emergency room wait times and service. He said a third-party company assists in finding physicians and nurse practitioners for the emergency department, and ORHC has worked to increase accountability.

"We meet with them regularly and we are getting better quality providers," Kiefer said. He also added that the hospital is looking to install its next great leader and feels it's close to hiring that. Recently, the hospital added a new leader for its emergency department nurses, and has seen a 25% decrease in the amount of time people are spending in the hospital's emergency department in two months.

"We are much better than we've been, and we're on a trajectory to get even better than that," Kiefer said.

As Kiefer works to spread the confidence he has in ORHC's quality and improvements amongst the community at large, he also said he hopes with that will come more community pride in Ottumwa itself.

"The community does not speak well of itself," he said. "You read things that people post online and they degrade the community. I've lived in a lot of different places, I think Ottumwa is a fantastic place. I think it has so much to offer. And we've got to reverse that [negativity]. We can't have a great hospital, and a great reputation as a hospital if people just don't feel good about where they live. We need to put our best foot forward as an organization, and also as a community.

"That's my call to action for each one of you today. Let's build up the community. Let's talk about the great work that GOPIP does, let's talk about the great job the schools do at educating. There's so many great things here and if we band together and talk about the good more than we talk about the bad, I think everyone will come out a winner."