An Interview with Dennis Berens

by Beth Blevins

Dennis BerensUntil he retired (“migrated”) last month, Dennis Berens was the director of the Nebraska Office of Rural Health (ORH), a position he held for 22 years. He is now in charge of Nebraska Times LLC. Berens says his biography can be summarized simply as: “farm boy by birth; teacher by training; newspaper publisher by accident; public servant by choice; and, consultant by request.” It was as a newspaper publisher, advocating for small rural towns, that Berens caught the eye of then-Nebraska Governor Kay Orr, who tapped him for the ORH post in his state.

In 1997, the Robert Wood Johnson Foundation named Berens a Community Health Leader and awarded him $100,000, which he used to start the Rural Health Institute, a coalition of providers and other health care leaders, and to seed several Community Health Leadership Programs, which last year awarded a $10,000 grant to help the Box Butte Health Foundation become focused as a community health foundation.

Berens said he doesn’t “really have any hobbies since I considered work my hobby.” But in his spare time he occasionally fishes and hunts. He also enjoys reading nonfiction and attending plays, dance and other types of theatre. He is married to “the girl of my dreams,” Charlyne, whom he met on his first day at Concordia College in Seward, Neb. They have two daughters and three grandchildren. Berens says of his daily life, “I really enjoy getting up every morning because I don’t know exactly what I’ll learn or who I’ll meet, but I just know that it’s going to be an exciting day!”

As you look back over your career, what are you most proud of?

For me, it isn’t so much the outcome as the process of bringing people together to solve the day-to-day issues, but also to constantly build new leadership. The issues now are not coming in 5-10-20 year increments; they’re coming in minutes, hours, days. So this whole concept of “leadership,” is crucial right now, that we have people who take the best knowledge that’s available and work with partners, friends, neighbors, and constantly improve the communities in which we live.

I am thrilled about the people within our state and around the country and world who were willing to work on today’s issues and also look into the future. These relationships sustain us now and I am sure into the future. The bottom line for me is that we actually helped rural people with some of the issues they were and are and will be facing.

One of your big concerns has been rural EMS. What sparked your interest?

In early ’91, I’d been on the job six months, and traveling the state. I quickly discovered, as anybody who travels in rural America discovers, that you don’t have a lot of professional health providers, but you do have a lot of EMTs. And you don’t have a front-end source on mental, dental and medical other than EMTs. So I thought, we need to create a front-end model that can be welcomed into people’s homes, check on them, with enough information and enough training to say, “We’ve got this problem” and then be able to help the person get to an adequate provider for whatever the issue is. We had aging in place issues, people coming home from surgeries that, other than a neighbor or two, didn’t have family. So from ’91 to 2007, this was gnawing at me, and whenever I went to a meeting I brought this up saying, “What can we do?”

In 2000, NOSORH and 13 states including Nebraska agreed to talk about the rural frontier EMS agenda of the future. Since then, we’ve been joined by four provinces of Canada and 11 other nations and have created the International Roundtable for Community Paramedicine.

What came out of that?

At the end of 2006, we got together in Nebraska and in a day and a half created CHEC – Community Health and Emergency Corporation. One of our goals was to develop a “community health paramedic” (CHP) model. We found money to write a curriculum, we got input from around the world on what was needed, what they were doing, and looked at things including the Alaska community health model and what was going on in Australia and Nova Scotia, Canada.

A doc in Minnesota asked to be our start up pilot and set it up at Hennepin Technical College. And then the Eagle Co. ambulance service in Vail, Colo., asked to be the next pilot. They served people who work in Vail but live outside it—they are too poor for health insurance, so they wait too long to get medical services. Now the third curriculum is out there at 11 different sites, with CHP training through Colorado State. We also are in various training efforts in the other partner nations around the globe.

The docs in Eagle Co. love it—they’re not eating as many expenses from charity care. Hospitals love it. Paramedics love it. When they aren’t out in field, they can go check on Ethel’s blood pressure and, if necessary, send it to her physician’s office to get another check on it. With a little bit of knowledge and a laptop with a wireless connection, you can send needed information from the home. In another year, we’ll see if this model makes sense. But it needs funding—my team is working on it, and it now needs a full time coordinator.

Were there or are there any other obstacles to putting the CHP model in place?

We knew as soon as word got out that people would come after us and say we were changing the scope of practice and you can’t do this unless you go through all the formal hoops. But that’s just a guild mentality, not a “how can we provide the most local care possible?” mentality. Paramedics are paramedics, but this education will allow them to go into a home for non-emergency situations and make public health assessments. The good news is that the Minnesota legislature has formally approved this model and Medicaid payment, which means that some insurers will have to pay for this. Nurses seem to have an issue with this model but we believe that with more information and more collaborative care models developing they will see the advantage of having another provider of care in our remote areas.

How else can we ensure the future of rural EMS? And why is this relevant to non-rural people?

The big problem with EMS is that we have to pull it out of transportation and put it inside health and human services—to pay for expertise, not just miles. Which means that you have to recognize the expertise. But we live in a guild-oriented world that sees them as transporters and not providers. If we use international language I think it will be more accepted. Understand that we’re the only country in the world that uses the term “EMTs”—everyone else calls them paramedics. But paramedicine is not as accepted here since “para” sounds like “less than.” We also need to better understand the roles found at each level of the EMT model and better utilize those providers.

My vision was that we would create a single model that would be certifiable in every nation in the world. If you were certified in Australia to be a CHP, you could move to Nebraska and be a CHP. But you’ve got to bust up a lot of guild mentality to put this into place. I mean, why must a nurse start at ground zero to be a doctor? Why must an EMT start at ground zero if he/she wants to be a nurse? Will this happen in my lifetime? I don’t know.

Even with health care reform, there’s going to be 16-20 million without health insurance. We have to figure out the non-institutional, front-end type of approach because the model we have in America right now is just way too expensive for the payment structure we have. So the CHP is at least a starting point for discussion.

Why is rural America so important to you?

I love rural communities—it’s what I grew up in. I grew up on a farm next to a rural town of 400+ people (Charter Oak, Iowa). We didn’t have indoor plumbing until I was seven. I grew up in a family that cared for each other and the people that we called friends and neighbors. I understood the many types of communities that exist in our lives, and wanted to help all of us understand the value of our rural people and places. Rural is the “shelter belt” of our states and nation. Although for the last ten years I’ve lived in Lincoln, I still travel the highways and byways and am thrilled to meet and work with rural people.

What do you think rural communities need to focus on in the future in order to survive and thrive?

Right now I think they should focus on developing a way for passionate/visionary leaders to evolve, knowledgeable leaders who see other paradigms are crucial for our rural communities. They also need to tell a better story about their lives and the assets to be found in rural places and people. We are at an opportune time for rural places to benefit from the many transitions/transformations taking place.

From my vantage point, rural America is now in what I would call the final transformational time. Some rural communities will continue to survive and sustain themselves, and some will not. I would like to help communities visualize their resources as assets. America is now more than 70 percent urban dwellers. We’re seeing what happens when you become very urbanized. Many of the problems that make the front page, in my opinion, are because of urbanization. Not a new issue in our world.

So I’m looking at what I think is the front-end of a Renaissance model for rural America and much of rural in the world because it’s going to be based on this huge need for water, food, energy and new products made from what is already being grown. We’ve got to look at the commodities that we grow—do we really want to ship them all off to a large corporation, out of state, to come back to us as cornflakes or do we want to go back to the past when we had some of those production facilities close? We have been able to do it only because of cheap transportation, cheap fuel. There’s a new food production model that we might put ourselves into.

But the big issue is quality of life. There’s an imprint in your brain that happened before the age of 10 for a particular type of place, food, and smell. And when you hit those, your brain lights up and says, “This is so good!” It may be your grandmother’s caramel rolls, or it might be an old rural, general store with a certain look and feel. How many people have an imprint for rural America in their psyches—whether for a little rural town, a farm, a ranch. What is that? And how can we begin to identify that, package it, and help you find the place where you can live out this imprinted value.

All these things lead me to believe that we could have the potential for a rural Renaissance. How all that comes together is going to take a lot of partners working very intently on the asset side as opposed to the debit side of the story. I’d like to be part of the discussion, the planning and the envisioning. Out of that, I hope will come a new model for community and economic development, and health delivery systems. It’s a grandiose idea, but I feel very strongly about this.

Getting back to what you said at the beginning about building new leadership. What characteristics make a good leader—and what advice would you give the next generation of rural leaders?

You have to care. You must be a passionate advocate, and you must develop relationships that can and will lead to good work being done for people and their communities. You must also be a risk taker because you will be the paradigm breaker/visionary that others will find hard, scary or threatening. That’s why you need good partners.

What do you plan to do next? You’ve mentioned that you want to devote more time to your Nebraska Times LLC. What is an LLC, and what is its focus?

My new work will be done under my Nebraska Times, LLC (Limited Liability Company). This model will allow me to be a working private citizen who can continue working in, with and for rural areas. It will also allow me to work with wonderful partners/consultants to provide the knowledge needed by rural communities and their leaders. The “spider web” of life in rural areas needs to be taken into account as programs, projects and people try to help rural communities. I want to help with the weaving of that web and with connections that this web should have to aid rural people.

Why is it called Nebraska Times LLC?

It’s a trade name. I live in Nebraska; these are the times I live in. From these times and from this state, I continue to learn what it means to live and work in rural communities with rural people. I’ve kept the name for the same reason I keep my high school graduation ring—as a reminder for me to stay grounded. What you learned, where you’ve learned it. If that learning can be applied worldwide or in another state, so be it. It’s quirky, I know.

I have a lot of partners who have been asking me for years to do things I couldn’t do inside of state government. I don’t know if they’ll still be interested in me working on those projects. But I want to use that expertise, that knowledge base, to try to help others, as I’ve done all my life, whether it was in education, or newspapering or public service. I hope to have lots of partners, working on lots of different projects, for as long as this body and brain hold out.

What is the key to getting people to come together around an issue or initiative?

Finding a shared vision and the reason that this is effort is worth advocating for and actually doing work to make it happen. People want to be part of something that is important and helpful to themselves and others. We just need to have someone paint a clear vision for us and help us to put that vision into action. Mentoring and nurturing are crucial, as is focus on sustainability. Together we can change the world.

Opinions expressed are those of the interviewee and do not necessarily reflect the views of the Rural Health Information Hub.

Back to: Summer 2012 Issue