Holly A. McCormack, DNP, RN, President and Chief Executive Officer at Cottage Hospital

Summary

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Podcast Summary: Becker’s Healthcare Podcast – September 1, 2025

Episode Overview

In this episode of the Becker’s Healthcare Podcast, host Laura Dearda sits down with Holly A. McCormack, DNP, RN, President and CEO of Cottage Hospital, a rural critical access hospital in northern New England. The conversation delves into successful workforce strategies, the unique challenges of rural healthcare management, leadership experiences, navigating financial pressures, the evolution of healthcare delivery, and what it takes to thrive as an independent hospital in today’s landscape.

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Meet the Guest & Cottage Hospital (00:14–01:23)

• Holly McCormack:

  • Registered nurse by background; has spent 15 years at Cottage Hospital, transitioning from Chief Nurse to CEO.
  • Reflects a "grow our own" philosophy, exemplifying a clinical-to-executive career path.

• Cottage Hospital at a Glance:

  • 35-bed critical access hospital.
  • 25-bed main inpatient unit; unique 10-bed unit devoted to acute geriatric psychiatry.
  • Level IV trauma center.
  • Rural health clinic attached and multi-specialty RHC status.
  • Operates independently, serving a rural population.

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Major Success: Reducing Traveler Reliance & Winning on Workforce (01:36–03:34)

• Workforce Challenges Post-Pandemic:

  • Struggled with staffing especially in nursing, nursing assistants, and radiology technicians.
  • High costs from reliance on travel staff were financially taxing.

• Bold Action: Nursing Pay Scale and Culture:

  • May 28 announcement of an aggressive new nursing pay scale to become competitive with academic centers.
  • Result: Hired 24 registered nurses, significant for a workforce of about 200 FTEs.
  • Traveler positions dropped from 21 in April (near all-time high of 23 during pandemic) to 10 by August—a 48% reduction.

“Since we did that on May 28, we have hired 24 registered nurses to our organization, which is incredible... If you count our per diems, 24 is significant.”
— Holly McCormick (02:23)

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Driving Force Behind Nurse Recruitment (03:59–05:49)

• Key Factors in Attracting Nurses:
  • Positive, Nurse-Led Culture: Longstanding reputation as a supportive environment.
  • Career Pathways: Investment in a clinical ladder, succession planning, and visible examples—Holly herself rising from nurse director to CEO.
  • Financial Prioritization: Chose to invest in people over equipment this budget cycle, signaling strong value of staff development.

“I think this model that we’ve come up with, along with the investment, definitely shows that we value our staff.”
— Holly McCormick (05:46)

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The Value of Clinical Leadership Experience (05:49–07:50)

• Unique Perspective of Nurse-Executive:
  • Direct bedside experience informs decisions about staffing and clinical care.
  • Deep understanding of workload complexity, not just patient numbers.
  • Ability to communicate credibly with clinical teams and relate to their daily challenges.

“I’ve held every position in nursing... I understand what those jobs entail and I understand how difficult the work is. Having walked in the shoes helps me make clinical decisions, it helps me make staffing decisions, and it helps me relate when there are problems in the hospital.” — Holly McCormick (07:16)

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Top Current Issues for Cottage Hospital (08:06–10:20)

• 1. Government Payer Changes & Regulatory Uncertainty

  • Watching impacts from Medicare, Medicaid, and the "One Big Beautiful Bill Act" (OBBBA).
  • Curiosity and caution around rural health transformation provisions.

• 2. Workforce & Recruitment Challenges

  • Ongoing need for key staff, especially in specialty roles (rad techs, lab techs, RTs).
  • Limited training programs in the region create “employee deserts.”

• 3. Financial Efficiency & Technology Adoption

  • Margins remain tight; every investment must be scrutinized.
  • Exploring AI not just to augment but to supplement workforce and drive operational efficiencies.

“There are very few programs in this area in northern New England for rad techs or for respiratory therapists. And so that creates these little deserts in this area of those particular employees.” — Holly McCormick (09:36)

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Opportunities for Strategic Growth (11:04–12:20)

• Expanding Outpatient Services:

  • Targeting growth by aligning specialty services to community need (e.g., neurology through regional provider partnerships rather than full-time hires).

• Behavioral Health:

  • Plans for expanded support—pre- and post-hospitalization—leveraging the hospital’s geriatric psychiatric unit as a community anchor.

“Those are a couple of opportunities that I think are right there for us... looking for ways to attract specialty providers... grow our behavioral health services.”
— Holly McCormick (11:04)

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Leading Through Change: The Essentials of Modern Healthcare Leadership (13:18–15:07)

• Nimbleness and Focus:

  • Need to stay flexible, informed, and ready to pivot as regulations and community needs evolve.
  • Ongoing education, advocacy, and communication at state and federal levels are crucial.

• The Power of Partnerships:

  • Remaining independent but actively partnering with neighboring organizations to pool resources and services.
  • Commitment to advocacy, particularly to educate and influence policymakers about rural healthcare realities.

“We can still be independent, but we can develop those partnerships with other organizations around us so that we can support one another.” — Holly McCormick (14:46)

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Memorable Quotes & Notable Moments

• “You know what it takes each day at the bedside to take care of our patients...you can’t just look at the model of X number of patients per number of staff—there’s nuance.”
  — Holly McCormick (06:25)

• “Being nimble all the time... It is important that we’re nimble. It’s important that we remain focused...so that we can make sure that our organization flexes as it needs to meet the needs of our community.”
  — Holly McCormick (13:30)

• “We’ve been here 122 years. We’d like to be here another 122.”
  — Holly McCormick (13:49)

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Key Takeaways

• Workforce wins in rural healthcare are possible through bold investment and a strong work culture.
• Leadership deeply rooted in clinical experience builds credibility and alignment with clinical teams.
• Adapting to payer changes, recruiting niche specialists, and leveraging technology are front-of-mind challenges.
• Strategic partnerships and advocacy are essential to independent rural hospital survival.
• Nimbleness and continued organizational learning are critical to thriving over the next five years.

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Transcript

[A]

This is Laura Dearda with the Beckers Healthcare podcast. I'm thrilled today to be joined by Holly McCormick, President and Chief Executive officer at Cottage Hospital. Holly, it's a pleasure to have you on the podcast today.

[B]

Pleasure to be here, Laura. Thanks for inviting me.

[A]

Absolutely. Now, I know we've got a lot to talk about. There's so much happening in healthcare today and in particularly a lot of innovation in just kind of transformation of the care delivery process. But before we dive into that, I'm curious, can you tell us a little bit more about yourself in Cottage Hospital?

[B]

Sure. I'm Holly McCormick. Like I said, I am a registered nurse and I am the CEO here at Cottage Hospital. I have been here for 15 years in a couple of different capacities. I was the chief nurse before becoming the CEO. And Cottage Hospital is actually a 35 bed critical access hospital, which is a distinguishing mark for us. We have 25 bed inpatient unit plus 10 bed distinct part unit that is dedicated to acute geriatric psych. So that is something that we do differently here. We're also a level four trauma center and we also have a multi specialty RHC rural health clinic attached to us. The rural health center. And we're an independent critical access hospital.

[A]

Absolutely. That's fantastic to hear and definitely a unique place you're in, especially in the healthcare ecosystem right now. That's awesome to hear. I'm wondering, what's your biggest winter success story from the last year or so?

[B]

I would say that one of our biggest achievements has actually happened just over the last couple of months. We have been struggling since the pandemic with workforce and particularly some particular categories. Nursing, our nursing assistants, the radiology technician space. And so my senior team came together and we had a conversation about what can we do about this. We have had unprecedented amounts of cost attributed to travel staff and quite frankly, that was really pulling our hospital down. And we said, you know what, we have to do something about this. We have to do something bold. And so we made a very aggressive investment in our staff. And on May 28, we announced a new nursing pay scale that we're hoping, hoping makes us competitive even with one of our biggest competitors for staff, and that's the academic medical center near us. And so since we did that on May 28, we have hired 24 registered nurses to our organization, which is incredible. It doesn't, you know, if you're, if you're from a bigger hospital or from a system that sounds like nothing, but when you're in a hospital where we have 200 FTEs and 300 employees. If you count our per diems, 24 is significant. And so I think that's something that I'm extremely proud of. And that's been a huge win for us. And so we're hoping that's going to help us decrease the amount of travelers within our organization. In April we were at 21 travelers, which was pretty close to our all time high. Even during the pandemic, the highest number we ever got to was 23. And today as we sit on August 7th, we are at 10 travelers. So that's a 48% reduction in travelers since. Since that April D so that is a huge win for us.

[A]

Well, that's amazing to hear and as you mentioned, does make a big difference, especially for an organization of your size. You know, what do you think made the difference in being able to hire on 24 registered nurses? I know it's not always easy to bring staff into especially rural settings. And so, you know, how were you able to do that? What really attracted them and got you into a spot where you could make some such a large number of hires?

[B]

Well, the one thing that we've always had on our side is culture and we have a very positive culture in this organization. I think it is attractive to nurses to work in a nurse led organization. So that was something we had on our side. But for quite some time we've been struggling with the pay scale piece and we decided that that was a place that we really had to invest in our people. And so although it was going to be difficult and it meant some shifts in the way we were think instead of investing in equipment this year, we knew we had to invest in this budget cycle in people that we did then we managed to pull together the chief nursing officer did a little redesign of how the nursing reporting structure looked. I think that all of these pieces coming together at this point in time has really created such positive movement and positive energy of empowering the nurses, making a nursing staffing model that allows for growth and development. And so you can see a path forward from even an investment in the nursing assistant program. And so our nursing assistants and then to the RN program and then there's a path for them through a clinical ladder program and also through succession planning for charge nurse, for house supervisor roles, for assistant nurse manager to director to the chief nurse to the CEO. And people can see that in this organization because I was a director here, I was a chief nurse and now I'm the CEO. So you know, it's we, we like to grow Our own. And I think this model that we've come up with, along with the investment, definitely shows that we value our staff.

[A]

I love that that's such a clear and complete way to think about things. And as you mentioned, you know yourself, having that nursing background and the foundation within clinical care, I can imagine makes a big difference when nurses can see that growth and that career pathway. And with that background, I wanted to dig one bit deeper in there as well. From a leadership perspective, what are you able to do because you have that nursing in clinical background, that someone without that experience may not have the same kind of frame of reference or credibility with the clinical staff?

[B]

It definitely gives you a different lens in this seat. You know what it takes each day at the bedside to take care of our patients. I understand the acuity of an assignment. I understand it better than just a model of we have X amount of patients and we need X amount of staff. I understand the nuances of what goes into that. And I'm able to have conversations with the nurse leaders about staffing and appropriate staffing. And that's really important because, you know, it's not just a one size fits all. It's something that we need to look at every day. And as we're marching forth our path for this hospital, we have to be so careful with how we spend our money, but we can never sacrifice quality. And I think having worn the hat, I've held every position in nursing. I started off as a candy striper, I've been a nursing assistant, I've been a staff nurse, a charge nurse, manager, director, a chief nurse, and now the CEO. I understand what those jobs entail and I understand how difficult the work work is. And so I think that being able, having walked in the shoes helps me make clinical decisions, it helps me make staffing decisions and it helps me be able to relate when there are problems that occur in the hospital or situations that arise. It gives me a little bit of a different lens than you might typically see.

[A]

Absolutely. I love that. And thank you for a little detour there. And looking at nurse leadership, especially now when you're looking at what's happening today, one of the top or three issues that you're focused on right now, what's top of mind in many of your discussions and the decisions you're having to make.

[B]

You know, I think it's probably the same for all of us in healthcare right now. We're looking to see what's going to happen with a lot of the changes with our government payers, Medicare and Medicaid in particular and things that are related to the OBBB A. So that's I think top of mind for everybody everywhere we go, all of our meetings. And with that it's are there opportunities also? There's a, you know, an entire portion of this that's developed to rural health transformation. And so I think, you know, while we're very nervous about what's happening around the payers and with Medicaid, we can also see this opportunity in there with the rural health transformation. And kind of curious what that's going to look like as it unfolds for those of us that are here in the rural health space. In addition to that, I think still working on workforce a lot. I mean we've, we've made progress with our nurses, we've made progress with nursing assistants. There's still a lot of work to be done. And maybe this even ties into rural health transformation with recruiting providers in the rural space and also with some specialties such as rad techs, lab techs, respiratory therapists. There are very few programs in this area in northern New England for rad techs or for respiratory therapists. And so that creates these little deserts in this area of those particular employees. And then I think the third issue that is top of mind at all times is just being very cautious and efficient and looking for those efficiencies within our day to day work because our margins are so razor thin and just making sure that all of our decisions are completely thought out and looking for any opportunity we have utilizing AI technologies when we can. And so that's not typically just to augment our workforce but to supplement our workforce because there's so much we can do with those technologies out there. So I guess those top issues that we're looking at are very varied. But that's a typical day in a critical access hospital, I think.

[A]

Absolutely. And I think all of those issues are so critical to the lifeblood of what makes the hospital taken. Certainly continue to grow and develop in the coming years so you can take care of the community. And I think especially you know, when you think about the tight margins, that is a scenario playing across, across, you know, most hospitals in this country. When you think about that and then knowing that you have to make these investments in the workforce, knowing that AI is continuing to grow its capabilities and you don't want to be left behind there, what do you see as really being the most important areas where you can continue to grow and develop in the next few years or so?

[B]

Definitely for our organization in particular, looking at growing our outpatient services. There's a lot of opportunity there. Looking for ways to attract specialty providers to our outpatient clinics. And it may not be something that we need. For instance, if we're looking for a neurologist, we may not have the volume to support a full time neurologist in our area. But trying to form those partnerships where we can work with other hospitals or organizations to bring those providers to our community for even a couple of days a month in order for our patients and our members of our community to be able to have those services and access them fewer closer to home. Also, we have a big focus right now on behavioral health. We're looking to grow our behavioral health services. It ties right into our ray of hope unit, which is our 10 bed Jerry psych unit. So looking for ways that we can grow the service lines to support those patients once they've left the hospital setting or even pre hospital setting where we can have outpatient specialty geriatric services. And so those are a couple of opportunities that I think are right there for us that we're looking at now.

[A]

It makes a lot of sense and, you know, I think it's just so critical to have that understanding. I can imagine, especially when you're looking out and seeing, you know, demographic changes and population shifts, it can be so helpful to think through what's going to be necessary in the next few years and what the community will demand as well. Right. Well, before we wrap up here, I wanted to ask one more question on leadership. What do you think it will take to lead a thriving organization in the next five years or so, given all of these changes? And certainly looking at technology, looking at some of the landscape and how it will likely evolve. We talked a little bit about Medicaid and Medicare as well on the one big beautiful bill act. So in looking ahead for all of those things, how do you make sure as a leader you're transformational, also understanding the very important realities that healthcare is facing today?

[B]

Yeah, there's a lot there. And I always think back to the CEO that was here at Cottage just before myself when I was the CNO and she used to use the phrase being nimble all the time. And that still holds true. It is important that we're nimble. It's important that we remain focused and that we are just really paying attention and reading and learning all we can about what's going on and what these changes are so that we can make sure that our organization flexes as it needs to meet the needs of our community. But also to make sure that we are still going to be viable to be here for our community. We've been here 122 years. We'd like to be here another 122. That's really important to us. I think as a CEO, it's important for me to be involved at the state and the federal level with advocacy work and speaking to our elected officials, educating them about rural health care and the challenges that we face here day to day. As we see start seeing how the OBBBA affects us, making sure we're communicating with folks about what that is doing for us or not for us. And so those are very important things for us to pay attention to. And I think that's the way we're going to thrive is to just make sure we are constantly focused and making sure we're communicating our needs and working with partnerships. When I was just talking about the future for Cottage Hospital, sometimes it's we can still be independent, but we can develop those partnerships with other organizations around us so that we can support one another.

[A]

I love that. Holly, thank you so much for joining us on the podcast today. This has been a really fun conversation. I look forward to connecting with you again soon, as well as seeing you at the CEO CFO Roundtable in November. I think, you know, such a critical time as we've been talking about today to have those partnerships and make those connections. And so it'll be really helpful to continue this conversation in just strengthening the network at Beckers.

[B]

Definitely looking forward to it. See you then.