The Eureka Springs Hospital has experienced a turnaround since Tiffany Means, DNP, MHA, RN, was hired as CEO in August 2025. Patient volume is up, and the ESH emergency department (ED) has some of the shortest wait times of any emergency room in the region.
“Since I’ve been here, I’ve worked hard to create a welcoming, accountable and patient-centered culture,” Means said. “We have an almost entirely new core staff. We made rebuilding a team a priority and have dramatically reduced our dependence on temporary staffing while recruiting people who are invested in this hospital and community.
“We developed a new mission and branding. I worked on the inside to create a transformation to rebuild a good reputation in the community, remodel the inside of the hospital, and ensure that each patient who comes here get the best care. Our ED utilization has grown significantly. Community confidence is returning. Patients are telling us they see and feel the difference.”
Currently ESH has more positive than negative comment on social media.
“The script has flipped, and people feel confident they can come here and get good care,” Means said. “EMS is now being told by patients that they are okay with going to ESH. Before, often patients didn’t want to come to ESH out of fear of not getting good care.”
Means said when she arrived, there were significant regulatory and operational issues requiring attention. Their focus has been to address identified deficiencies, strengthen processes and build a culture of everyday readiness, accountability and continuous improvement.
“I am a transformationist,” Means said. “I came in with the energy to work with the team to make it better for patients, employees and the community. The magnitude of the problems was more than I expected. I had to untangle a mess. But I have grit, purpose and am not a quitter.”
ESH launched Arkansas’s first Rural Emergency Hospital Hybrid Emergency Department/Minor Illness & Injury Urgent Care model July 14. Means said this was done because they recognized the community and the nearly 750,000 visitors each year need access to care 24 hours a day, but not every patient needs, or should have to bear the cost, of an ED level of care. The intention is to provide patients with the appropriate level of healthcare following the required medical screening process while helping reduce unnecessary costs. With Medicaid cuts, there are more self-pay patients.
“The urgent care option is far cheaper than an ED,” Means said. “We want to help people get the care they need at the lowest possible cost. We had more than 100 urgent care patients between July 14 and August 14.”
According to the 2026 Chartis Center for Rural Health State of the State report, 41.2 percent of rural hospitals nationally are operating in the red. In Arkansas, 59 percent of rural hospitals are operating in the red, the third-highest percentage nationally. Chartis also identifies 55 percent of Arkansas rural hospitals as vulnerable to closure, the second-highest percentage in the country.
“Rural hospitals across the country continue to face significant financial pressure, and ESH is not immune to those challenges,” Means said. “Our focus is on strengthening revenue cycle performance, controlling expenses, building outpatient services and partnerships, and developing a sustainable model for the future. When I arrived, a number of outpatient services had been reduced or were no longer available locally.
“We are now intentionally rebuilding and expanding access through local services, visiting specialists, partnerships and telehealth where appropriate. We are working on attracting more outpatient services so people don’t have to drive to get care for things like dermatology checks for skin cancer. We have a dermatologist who comes now twice a month and have started to offer physical therapy. Urology services are also coming. We are working on other specialties that can be delivered by telemedicine.”
ESH has recently established the Eureka Springs Hospital Foundation, which has received 501(c)(3) recognition. The Foundation creates new opportunities to pursue charitable support and grants that can help strengthen healthcare services, equipment and infrastructure for the community.
“My responsibility as CEO is to make sure our resources are used responsibly and reinvested in patient care, our people, our facility and the long-term sustainability of healthcare in this community,” Means said. “I’m here to make sure profits are reinvested in the hospital. We have made meaningful progress in reducing expenses, strengthening financial oversight and improving our revenue cycle. Our goal is to build an operation that is financially sustainable month after month. Doug (interim CFO Doug Hoban) and I meet at seven each morning. We have good diagnostic equipment, new lab equipment, and are making progress in making the hospital sustainable.”
Means said in rural healthcare especially, sustainability is going to require innovation, partnerships and a willingness to create models that may look very different from traditional healthcare.
“Over the past year, we have worked intentionally to rebuild culture and accountability, strengthen regulatory compliance, stabilize staffing and dramatically reduce our dependence on travelers,” Means said. “We have worked to become better stewards of our resources, evaluate expenses and vendors, strengthen our financial oversight and address longstanding operational and revenue cycle challenges. At the same time, we have not allowed those challenges to stop us from moving forward.
“The goal is not simply to keep the doors of a rural hospital open. The goal is to determine how a rural hospital can evolve to meet the needs of the community it serves and become sustainable for the future. Patients, our team and this community remain at the center of that work. There will continue to be challenges, pivots and difficult decisions along the way, but there is also tremendous opportunity.
“We are not trying to recreate the hospital of the past. We are building the hospital this community will need for the future. For me, rural healthcare leadership means acknowledging challenges, fixing what needs to be fixed, learning from it, and continuing to move forward.”