Growth can be difficult to measure, especially for an ever-changing industry such as health care.

For instance, if Flathead County’s spurt in health-care growth was measured solely by square footage, then the industry as grown immensely. In the last six years alone, providers countywide created an additional 595,000 square feet of new health-care facilities worth nearly $150 million, according to a report from the Kalispell Chamber of Commerce.

If growth is measured by economic contribution, then again, health care has grown by leaps and bounds. As the county’s largest industry, health care employs nearly 6,300 people and provides $313 million in annual payroll to its employees. According to a 2016 report from Kalispell Regional and other county resources, if the economic growth continues, it is estimated that more than 1,000 additional health-care jobs will be added in the county by 2024.

These measurements of growth are tangible. Local residents can work toward a degree at Flathead Valley Community College’s new Nursing and Health Sciences building or seek services at the new gastrointestinal facility and expanded emergency center at Kalispell Regional Healthcare, among other recent structural expansions.

Another measure of growth is the 190,000-square-foot Montana Children’s Medical Center. The $40 million first floor of the center — scheduled to open in May 2019 — is aimed at making Kalispell Regional a regional destination for pediatric care.

But growth can also measured by factors not as tangible, such as relationships cultivated through that growth.

One such relationship is the 2016 affiliation between North Valley Hospital and Kalispell Regional Medical Center, which executives laud has been one of the most noteworthy advancements in recent years — a partnership that allows the two hospitals to “highlight” one another’s resources, according to Kevin Abel, chief executive officer of North Valley Hospital.

Kalispell Regional’s relationship with the community has been more challenging in recent years.

In recent months, the organization has been hit by a couple of lawsuits that have temporarily tainted the hospital’s reputation and swayed its trust with the public, according to hospital executives.

“There’s been a lot of transition here over the past two or three years and I think a lot of historical trust with our community that has been eroded,” said Jason Spring, Kalispell Regional’s chief strategic officer.

In September, the hospital agreed to pay $24 million to settle a whistleblower lawsuit that, in a nutshell, alleged the organization steeply overpaid some of its physicians.

The lawsuit brought by Jon Mohatt, the former chief financial officer of Kalispell Regional’s Physician Network, alleged Kalispell Regional knowingly violated federal anti-kickback and compensation statutes dating back to at least 2011, under its late Chief Executive Officer Velinda Stevens. The settlement ended a federal investigation into the hospital’s compensation and referral practices.

Following the settlement, Kalispell Regional released a letter stating among other things: there were no findings by the Department of Justice that confirmed any allegations and they settled because the cost of fighting the government can be “significantly greater than the cost to settle.”

The letter concludes, saying “any loss of trust, in our opinion, is more costly to us than the considerable financial losses from this settlement. We are committed to regaining that trust.”

Then on Dec. 5, less than three months after the whistleblower lawsuit, the Montana Nurses Association filed charges against Kalispell Regional, alleging the hospital had engaged in unfair labor practices and was impeding the nursing staff’s ability to unionize.

The lawsuit, currently ongoing, emerged after Kalispell Regional’s Chief Nursing Executive Teresa Fisher announced to charge nurses their positions had been eliminated and they could apply for a new “shift unit supervisor” role. However, according to a hospital press release, the transition was described as a “leadership restructuring” that would include modified titles, roles and responsibilities to an estimated 130 employees and they anticipated “minimal involuntary departures.”

Kalispell Regional offered little communication to the public throughout both lawsuits. Executive leadership said this was due, in part, to legal restrictions on what they could and could not relay to the public.

“One of the most challenging things for us throughout this process has been our ability to effectively communicate and when you’re in a position where there is something that big going on and you can’t talk about it, that naturally is going to challenge the trust that people have,” said William Gibson, interim chief executive officer for Kalispell Regional.

Questions regarding the hospital’s financial stability also have emerged after the whistleblower settlement was followed shortly afterward by the alleged “laying off” of more than 100 employees — two events that have not been confirmed as being correlated.

“It’s difficult and expensive to run a medical practice; it’s a business,” Gibson said. “We have had a lot of activity over the last year when it comes to our finances. We were in a situation where we did not have a positive margin. We were looking at a negative margin and obviously you can’t keep that up.”

Gibson cited the adage, “no money, no mission” and said the hospital has moved to integrate a few different financial strategies, including the hospital’s shift to a value-based model in recent years, something he said may ultimately reduce costs for patients.

“Traditionally you come in, you get a service and the hospital gets paid for that service. What we’re talking about now is an entirely different paradigm where we’re paying people based on the value of the care that they’re giving,” Gibson said.

Moving forward, the hospital plans to focus on introducing more innovative technology — something leadership executives claim has been the hallmark of the organization for decades.

“You ask where we’re going one day, and I think the key word for not only Kalispell Regional for the past 10 years, but going forward is ‘innovation,’ and we’re going to have to innovate in several ways, but they’re all going to be focused on the patient,” Spring said.

Overall, Kalispell Regional’s leaders claim focusing on the patients requires rebuilding trust and transparency with the community, something that will be paramount moving forward into 2019 and beyond. They say they want to move past the “noise” curated by 2018’s legal obstacles.

“I think that open and honest communication is the best thing that we can do to rebuild trust with those that may doubt our sincerity,” Gibson said. “We are grounded to our mission that is about providing great care to our patients and everything that has happened with respect to the lawsuit has been a very unfortunate distraction from that mission.”

The mission touted by executives is one that has remained largely unchanged.

In a book about Kalispell Regional’s history, “The Biggest Little Hospital in the West,” a 1991 quote from Dave Prieto is printed on the last page: “Change. That’s the buzzword at Kalispell Regional Hospital, where the future is always being planned with the health needs of the Flathead Valley foremost in the planning.”

Reporter Kianna Gardner may be reached at 758-4439 or kgardner@dailyinterlake.com.