Community Health Center Management Principles for Boards and Senior Managers - Principle 19

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 19 – Decision Making

· Know that when a decision is brought to you, the material presented is based on opinions not facts.
· Ask:
1. What would the facts have to be to make this opinion relevant?
2. What are the criteria of relevancy?
3. What are the measurements for the criteria?

Next series: A Story Told about a Community Health Center -- How an Executive Director Took Advantage of Her Consumer Board, and How the Consumer Board Allowed It to Happen - – A Case Study in Several Parts

Community Health Center Management Principles for Boards and Senior Managers - Principle 18 - Managing Your Boss

Community Health Center Management Principles for Boards and Senior Managers - Principle 18 - Managing Your Boss

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 18 - Managing Your Boss

· Make his strengths effective and productive:
1. What can he do?
2. What does he do well?
3. How can you concentrate his time, effort, and resources to the essential needs of the organization?
4. How can you help him address one essential task at a time?
5. How can you assist him to slough off the past that is not productive?


Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 19 – Decision Making

Community Health Center Management Principles - Principle 17 - Humans Are Perceptual Beings, Not Logical Beings

Community Health Center Management Principles - Principle 17 - Humans Are Perceptual Beings, Not Logical Beings

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 17 - Humans are perceptual beings, not logical beings
· Perceptual:
1. Insight
2. Intuition
3. Discerning ( to perceive or detect)
4. Knowledge gained by being aware directly through the senses, viz., to see,
to hear, having the capacity for such insight.
5. Latin: To seize intensely.

Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 18 - Managing Your Boss

Community Health Center Management Principles for Boards and Senior Managers - Principle 16 - Managing for Results

Community Health Center Management Principles for Boards and Senior Managers - Principle 16 - Managing for Results

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 16 - Managing for Results
· Classification of results areas:
1. Today’s breadwinners
2. Tomorrow’s breadwinners
3. Productive specialties
4. Development of products or services
5. Failures
6. Yesterday’s breadwinners
7. Unnecessary specialties
8. Unjustified specialties
9. Investments in managerial ego
10. Cinderellas (sleepers)

· Rules to apply to results areas:
1. Any significant deviation of performance from expectations is likely to signal a change in classification.
2. Expectations must be written down ahead of time
3. There is a difference to every product (market, end-use, distributive channel). Analysis of the cost of further increments of growth shows where a product stands in the lifecycle, and what its life expectancy is.

· Satisfaction:
1. One doesn’t sell a product or service, one sells satisfaction (solutions).
2. One doesn’t buy a thing; one buys the satisfaction (the solution) and utility derived therefrom.

· Five keys to managing for results:
1. Neither results nor resources exist inside the business; business converts outside resources into outside results.
2. Results are obtained by exploiting opportunities - not by solving them.
3. To produce results, resources must be allocated to opportunities rather than to problems.
4. Economic results are earned by leadership, not by mere competence.
5. Any leadership position is transitory and likely to be short lived.


Next post: Community Health Center Management Principles - Principle 17 - Humans Are Perceptual Beings, Not Logical Beings

Community Health Center Management Principles for Boards and Senior Managers - Principle 15 - Systematic Time Spending (Organizing)

Community Health Center Management Principles
for Boards and Senior Managers - Principle 15 - Systematic Time Spending (Organizing)

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 15 - Systematic Time Spending (Organizing)

· Diagnostic questions:
1. Identify and eliminate the things that need not be done at all. Ask: “What would happen if this were not done at all?”
2. Which of the activities in my time log could be done by someone else just as well, if not better?
3. Delegation: Getting rid of anything that can be done by somebody else; so that I do not have to delegate, but can really do my own work.
4. What amount of other’s time do I waste?

· Pruning time wasters:
1. Lack of system or foresight (the recurrent crisis)
2. Over-staffing
3. Mal-organization
4. Malfunction in information


Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 16 - Managing for Results

Community Health Center Management Principles for Boards and Senior Managers - Principle 14 - Incompetence

Community Health Center Management Principles for Boards and Senior Managers - Principle 14 - Incompetence

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 14 - Incompetence

· Do not sanction incompetence:


1. If there is ignorance, then teach:
a. Help to develop.
b. Do not criticize
c. Teach them what they need, and teach them how to do it; do not criticize because they don’t know how to do it.
d. Teach the person how to solve what he would have been criticized about.

2. If there is negligence, address it:
a. Help others release their skills
b. Do not criticize, help to develop.
c. Teach them what they need, and teach them how to do it; do not criticize because they don’t know how to do it.

· Rules for not sanctioning incompetence:
1. There are no perfect people
2. If failure will hurt them or others, then take away the right to fail.
3. People have a right to a second and third chance
4. Teach others how not to be incompetent

Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 15 - Systematic Time Spending (Organizing)

Community Health Center Management Principles for Boards and Senior Managers - Principle 13 - Rules for Prioritizing

Community Health Center Management Principles for Boards and Senior Managers - Principle 13 - Rules for Prioritizing

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 13 - Rules for Prioritizing:
· Courage over analysis
· The future over the past
· Opportunity not problems
· Your own direction – not the bandwagon
· Aim high at something that will make a positive difference
· Revise priorities in the light of reality.

Next post: Community Health Center Management Principles for Boards and Senior Managers - Principle 14 - Incompetence

Community Health Center Management Principles for Boards and Senior Managers - Principle 12 - Decision Making

Community Health Center Management Principles for Boards and Senior Managers - Principle 12 - Decision Making

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 12 - Decision Making

· Questions to ask prior to making a decision:
1. Is the situation:
Degenerative?
Self-healing
A nuisance?
Something with which we will have to live?


2. What will happen if we do nothing?


3. Is action needed?


4. What are all the alternatives?


5. Ask:
§ The risks?
§ The costs?
§ The effort needed?
§ The time span required?

· Important features and elements of decisions:
1. Knowing whether the problem is generic, or an exception. (If generic, it can only be solved through establishing a rule or principle.)


2. Defining the specifications that the answer to the problem has to satisfy, i.e., its boundary decisions. (What are the clear specifications that the decision must accomplish?)


3. Thinking through what is right, i.e., the solution that will fully satisfy the specifications before the necessary compromises are made. (What is right vs. what is acceptable)


4. Testing the validity and effectiveness of the decision against the actual course of events, against the expectations that underlie the decision.


5. How to convert the decision into action (Effectiveness).

· The Decisional Process:
1. Decisions start with opinions – not facts.
2. What are the criteria of relevance?
3. Decisions spring from the clash and conflict of divergent opinions.


Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 13 - Rules for Prioritizing

Community Health Center Management Principles - Principle 11 - Thieves of Effectiveness

Community Health Center Management Principles for Boards and Senior Managers - Principle 11 - Thieves of Effectiveness

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 11 - Thieves of Effectiveness

Thieves of Effectiveness

1. Not owning your time

2. The flow of events

3. The organization itself

4. Being inside the organization’s filter


The Effective Response

1. Setting and adhering to priorities

2. Setting and adhering to criteria

3. An effective, personal plan to manage results

4. Planning for results outside the organization



Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 12 - Decision Making

Community Health Center Management Principles for Boards and Senior Managers - Principle 10 – What is Effectiveness?

Community Health Center Management Principles for Boards and Senior Managers - Principle 10 – What is Effectiveness?

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 10 – What is Effectiveness?
· Effectiveness: Doing the right thing (vs. Efficiency doing the thing right).
· Effectiveness is not a function of intelligence, hardwork, or good intentions.
· Intelligence, knowledge, and insight need effectiveness to convert them onto results.
· Effectiveness is a major practice of its own; it converts effort into results.
· Managers must be effective, because they cannot rely on the inherent utilitarian value (e.g., in a pair of shoes) of what they do.

Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 11 - Thieves of Effectiveness

Community Health Center Management Principles for Boards and Senior Managers - Principle 9 - Practices of the Effective Manager

Community Health Center Management Principles for Boards and Senior Managers - Principle 9 - Practices of the Effective Manager

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 9 - Practices of the Effective Manager
· Manages time
· Sloughs off what has ceased to be productive
· Decides which tasks to tackle (Prioritizes and stays with decisions – Sets the right priorities)
· Decides which tasks not to tackle (Posteriortizes - Picks the future over the past)
· Makes decisions at the highest level of conceptual understanding
- Is this a generic situation or an exception?- What is this decision to accomplish?- Have I started out with what is right? Knowing I will have to
compromise later?
- Can I convert this decision into work?
· Focuses on overall contributions rather than on the details of the work.
· Builds on strengths or self and others - mobilizes the correct strengths.

Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 9 - Practices of the Effective Manager

Community Health Center Management Principles for Boards and Senior Managers - Principle 8 - An Effective Manager’s Employee Evaluation Form

Community Health Center Management Principles for Boards and Senior Managers - Principle 8 - An Effective Manager’s Employee Evaluation Form

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 8 - An Effective Manager’s Employee Evaluation Form

a. Major Expected Contributions:

b. Actual Direct Results:


Hiring / Promotion Evaluation Form

· What has this employee done well?


· What has this employee done well in the past jobs (assignments)?


· What does this employee need to learn in order to do the essential job purpose?


· Would I be willing to have my daughter or grandson work under this person? - Why or Why not? -


Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 9 - Practices of the Effective Manager

Community Health Center Management Principles for Boards and Senior Managers - Principle 7 - Leadership

Community Health Center Management Principles for Boards and Senior Managers - Principle 7 - Leadership

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 7 - Leadership
· Authoritarian leadership addresses the effects.
· Participative leadership addresses the causes.
· Leader’s Integrity:
a. Does he ask: “What is the primary need of this organization; and, therefore my primary task and duty?”
b. Does he execute effectively on that answer?

Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 8 - An Effective Manager’s Employee Evaluation Form

Community Health Center Management Principles for Boards and Senior Managers - Principle 6

Community Health Center Management Principles for Boards and Senior Managers - Principle 6

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:

Principle 6 - Tools of the Manager
· The Meeting:
§ How to use it.
§ Does it have a purpose?
§ Have I done my homework for it?
§ Meeting types:
- Information to others
- Others to inform me
- Deliberative (for decisions or for opinions)

· The Report:
§ How to make it readable, understandable, implementable, and effective for others.
§ Who is going to read it?
§ What do we expect him to do with it?

· Control of Assignments:
§ Are the effective contributors doing what is important or what is difficult?
§ Are the effective contributors dealing with the issues of yesterday or tomorrow?

· Performance and Performer Appraisal:
§ Establish targets and standards, then appraise them based on
accomplishments.
§ What has the person done well?
§ What are his strengths?

· Development of People:
§ Are we developing them effectively or poorly?
§ Are we effectively using the tools of development (tasks, climate, and example)?
§ Are we challenging them?
§ Have we set performance standards?
§ Is the temperament there?
§ What strengths does he need to develop?
§ What is our placement responsibility?
§ Where does he really belong?

· Abandon Yesterday.

Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 7 - Leadership

Community Health Center Management Principles for Boards and Senior Managers - Principle 5 – Staffing

Community Health Center Management Principles for Boards and Senior Managers - Principle 5 – Staffing

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address:
Principle 5 – Staffing
· Management ability issues:
§ Knowledge (Does he know it?)
§ Skill (Does he do it? - Does he do it effectively?)
§ Values (Does he want to be liked or respected?)
§ Manners (Does he do it courteously? - Does he disagree without being disagreeable?)
§ Temperament (His manner of thinking, behaving, reacting
- Is he efficient? [Does the thing right]
- Is he effective? [Does the right thing]
- Is he efficacious? [Gets the thing done])
§ Experience (Does he have the historical of seasoning necessary for his essential job purpose?)

· Management staffing issues:
§ Is he able to do the work? (Does he have the requisite knowledge, skills, values, manners, temperament, and experience?
§ Does he know what he is expected to contribute? (Goals, standards, timetables, etc.)
§ Has the organization taken placement responsibility? (Staffed from strengths; Placing and assignment control; etc.)
§ Has the organization considered where the person really belongs? (Outplacement)

· Staffing from strengths (Four rules):
1. Jobs are not created by nature or by God. (Forever be on guard against the impossible job)
2. Make each job demanding. (Jobs must have challenge in them to bring out staff’s strengths)
3. Start with what an employee can do rather than with what the job requires. (Do your thinking about people long before the decision on filling a job has to be made)
4. To get strengths, one has to put up with weaknesses.

· Rules for managing the prima donna:
§ The prima donna’s job is twofold: When the playbill says Tosca, sing Tosca; and fill the house. When she fulfills that job, the effective manager will treat her as a prima donna.

Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 6 - Tools of the Manager

Community Health Center Management Principles for Boards and Senior Managers - Principles 3 & 4 – Focus on Results & Organizations

Community Health Center Management Principles for Boards and Senior Managers - Principles 3 & 4 – Focus on Results & Organizations

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

First:

Principle 3 – Focus on Results
· Focusing only on the direct visible results where your contribution is relevant.

Second:
Principle 4 – Organizations
· Purpose of the organization:
- To make strengths effective and weaknesses irrelevant.

· Each organization need contribution in three major areas:
- Direct results (the care and feeding of an organization)
- Building of values and their reaffirmation (what do our behaviors
indicate we stand for?)
- Building and developing people for tomorrow (making strengths effective
and weaknesses irrelevant)

Next post: Community Health Center Management Principles for Boards and Senior Managers - Principle 5 – Staffing

Community Health Center Management Principles for Governing Boards and Senior Managers - Principle 2 – The Five Habits of Effectiveness

Community Health Center Management Principles for Governing Boards and Senior Managers - Principle 2 – The Five Habits of Effectiveness

This is a continuing series for effective Community Health Center Governing Boards and Senior Management.

Today we address Principle 2 – The Five Habits of Effectiveness

With a continuing nod to Peter Drucker (see http://www.druckerinstitute.com/ ) we continue this series with Principle 2:

Principle 2 – The Five Habits of Effectiveness
· Know where your time goes
· Direct results
· Building on all strengths
· Concentrating on a few areas where superior performance will produce outstanding results (Doing first things first, and second things not at all)
· Effective decisions demand:
- The right steps
- Completed in the right sequence
- Based on the right strategy

Next post: Community Health Center Management Principles
for Boards and Senior Managers - Principle 3 – Focus on Results

Community Health Center Management Principles for Governing Boards and Senior Managers - Principle 1 - The Job of the Manager

Community Health Center Management Principles for Governing Boards and Senior Managers - Principle 1 - The Job of the Manager

This series of posts will address the nineteen principles of Community Health Center management. Each day we will set-forth a different principle for Community Health Center Boards and Senior Management to consider.
With a respectful nod to Peter Drucker (see http://www.druckerinstitute.com/ )
[This series of nineteen posts is based upon Drucker’s writings and interviews concerning management, leadership, et al.].

This series begins with The Job of the Manager - Principle 1:

Principle 1 – The Job of the Manager (What a manager does)
· To help ordinary people become capable of extraordinary contributions to the organization by staffing from strengths while utilizing:

§ Planning
§ Organizing
§ Staffing
§ Directing
§ Monitoring
§ Leadership

Next post: Community Health Center Management Principles for Governing Boards and Senior Managers - Principle 2 – The Five Habits of Effectiveness

Character Development - Thoughts on Community Health Center Governing Boards and Executive Directors

Character Development - Thoughts on Community Health Center Governing Boards and Executive Directors

We have talked a lot about Executive Director managerial development. We have been mostly talking about developing people's strength, and giving them experiences.

Keep in mind that character is not developed that way. Character is developed on the inside and not on the outside.

These are factors that need to be foremost in the minds and actions of Boards of Directors of Community Health Centers when they chose their Executive Director.

Next Post: Community Health Center Management Principles for Governing Boards and Senior Managers - Principle 1 - The Job of the Manager

Questions to Support the Universal Standards for Community Health Center Governing Boards.

Questions to Support the Universal Standards for Community Health Center Governing Boards.

Previously we summarized the Universal Standards for Community Health Center Governing Boards.

§ CLARITY (Is it clear and understandable?)

§ ACCURACY (Is it verifiable?)

§ PRECISION (Details/Specifics)

§ BREADTH (Is it too narrow or too broad a perspective?)

§ DEPTH (Applicable factors)

§ RELEVANCE (Help us understand?)

§ SIGNIFICANCE (Is it important?)

§ LOGIC (Does it make sense?)

§ FAIRNESS (Is it objective?)

Today we present additional questions to ask during the monthly Community Health Center Governing Board and Financial meetings, in your fiduciary role, as a Governing Board member:

Clarification
Did I hear you saying_____________________?
Have I missed anything?
Take a few minutes to think out loud, and I’ll try to catch on to your idea.

If it would help to sketch something on the board, let’s do it.
How would you explain that image to someone who has not had your experience?
I’m struggling with clarity. Can you restate your idea in an alternative way?

Summarization
So, would you say_______________?
Am I correct?

Reasons and Evidence
How do you know that?

Point of View
I am curious as to the basis for your point of view.
Why do you think this would be the case?
Is your point of view different now from two years ago?
Have you gotten all relevant points of view on this issue?
Which ones are missing?

Information
What information are we missing?
How can you determine if the source of the information is reliable?

Problem
Can you put the problem in the form of a question?

Assumptions
What assumptions are you making?
What would you say to someone who did not agree with your assumptions?

Consequences
What would be the implications of believing that?

Influences
What if the opposite were true?
If we grant that conclusion, where would that lead us?
Let me see if I understand; there was no problem until _________________?
So what made things seem different was when ___________________?

Goals
What are we trying to accomplish?
What would someone say - who did not agree with us?
Can you put the goal in the form of a question?

Next post: Thoughts on Community Health Center Governing Boards and Executive Directors - Character Development

Universal Standards for Community Health Center Governing Boards.

Universal Standards for Community Health Center Governing Boards.

Community Health Center Governing Boards are ofttimes both risk avoidant and conflict averse. To fully execute their fiduciary responsibilities, Governing Boards need to consistently display and practice the behaviors that ensure Executive Director and Senior Manager:

§ CLARITY (Is it clear and understandable?)

§ ACCURACY (verifiable?)

§ PRECISION (details/specifics)

§ BREADTH (Is it too narrow or too broad a perspective?)

§ DEPTH (applicable factors)

§ RELEVANCE (help us understand?)

§ SIGNIFICANCE (Is it important?)

§ LOGIC (does it make sense?)

§ FAIRNESS (Is it objective?)

Next post: Questions to Support the Universal Standards for Community Health Center Governing Boards.

Special Notes on Effective Problem Solving for Community Health Center Leadership.

Special Notes on Effective Problem Solving for Community Health Center Leadership.

Review / Use Round Robins.

Remain Socratic (ask questions).

Notice this is usually an iterative (repetitive) process for community health center problems.

Capture potential solutions along the way, but work the process to completion.

Don’t jump to solutions too quickly. You’ll get better results if you remain
disciplined with your thinking.

Be sure to separate the problem from the symptoms.

Avoid the temptation to shoot the messenger.

Refuse to participate in the all too human game of “who can we blame?”
This is a problem the Community Health Center Governing Board and Executive Director have either created or allowed to happen. Avoid blame, and seek a solution.

Next post: Universal Standards for Community Health Center Governing Boards.

The Critical Thinking Problem Solving Process for Community Health Center Leadership.

The Critical Thinking Problem Solving Process for Community Health Center Leadership.

Continuing our prior post, we present a suggested problem solving process for Community Health Center Governing Boards to utilize at their monthly Board and Financial meetings.

Extensive Questions

This post contains extensive questions. If your style as a Governing Board member has not been one of serious questioning, please note that any three of these questions, when responded to with answers that respect your intelligence and standing as a Board Member with fiduciary responsibilities, would immensely enhance the quality of Board policies and the quality of care for your underserved patients.

When presented with information, plans, financials, etc., our suggestion is that each Community Health Center Governing Board member follows this process, and asks at least three of these sample questions:

§ What is the outcome, or ideal state you are trying to accomplish?
What purpose are you trying to achieve?
State in positive terms and phrase as a question.

§ What is the problem, or question at issue, you are trying to solve?
Pose it as a question.
If you answered or solved this, will it get you to your goal?
Is it stated clearly, accurately, deeply considering the complexities of the issue or problem?
How are you defining the terms you use in describing the problem?
Would this definition make sense to the other stakeholders?

§ What are you assuming about the goal or the problem?
What evidence do you have for assuming what you are assuming?
Is the evidence accurate and precise?
If you don’t have all the evidence, what would you need, and where would you go to get it?

§ What data or information do you have to help solve the problem?
o If you don’t have enough data or information, what questions would you need to ask to get the relevant data?
o Where would you go?
o How would you determine the reliability of the data?
o Are you working with facts, or inferences?

§ What point of view are you coming from in analyzing the problem?
What other points of view would you need to consult and why?
Have you defined the problem broadly enough?

§ If you have completely defined the problem meeting the above criteria, what solutions or decisions can you come to regarding the problem you are attempting to solve?
What are the consequences of the solution (both positive and negative)?
How will you maximize the positive and minimize the negative consequences?

Next post: Special Notes on Effective Problem Solving for Community Health Center Leadership.

Critical Thinking for Community Health Center Governing Boards and Senior Managers

Critical Thinking for Community Health Center Governing Boards and Senior Managers

Questions Are the Answer

We have been asked for a few tips focused on the questions that Community Health Center Governing Boards need to ask their Executive Directors and Senior Managers at the monthly Board and Finance meetings.

Questions and Direct Answers

What we have found is that any of these questions will add value to your role as a Community Health Center Governing Board member. The key to these questions is to make sure that you have received an actual, direct answer to the questions asked. If not, simply rephrase the question, and then ask it again.

Our suggestion is that you anticipate not receiving direct answers initially, and prepare rephrased questions in advance.

Expert Salespeople

Remember that Executive Directors are expert and experienced salespeople. Make sure that your Executive Director has answered your questions fully and directly at the monthly meetings. There should be no need to “get back to you” with an answer. Senior Managers spend hours, prior to the meetings, anticipating the Board’s questions.

Some suggested initial questions:

PURPOSE:
§ What are you trying to accomplish?
§ Please put your goal in the form of a question
§ What would you say someone who did not agree with you?

PROBLEM:
§ Would you put that problem in the form of a question?

CONCEPTS:
§ How is that concept valid?
§ Please define your concept.

INFORMATION:
§ What information is missing from your report?
§ How reliable is your information?

ASSUMPTIONS:
§ What assumptions are you making?
§ Please outline your assumptions for the Board.
§ What would you say to someone who did not agree with your assumptions?

EVIDENCE:
§ How do you know that?
§ Help me follow your logic, please re-state that evidence.

INFERENCES:
§ If we grant that conclusion, where would that lead us?
§ Why?

CONSEQUENCES:
§ What are the implications of that conclusion?
§ How did you arrive at those implications?

POINT OF VIEW:
§ What is the basis for your point of view?
§ Is your point of view different from two years ago? [Note: Be careful of Executive
Directors and Senior Managers whose points of views have not grown, i.e. changed.]
§ How is it different?

Next post: The Critical Thinking Problem Solving Process for Community Health Center Leadership.

How to Reinvigorate People - Thoughts on Community Health Center Governing Boards and Executive Directors

How to Reinvigorate People - Thoughts on Community Health Center Governing Boards and Executive Directors

Within Community Health Centers there are people who hit a midlife crisis when they realize that they won't make it to the top, or discover that they are not first-rate.

The worst midlife crisis is that of physicians.
They have a severe midlife crisis. Basically, their work becomes boring. Just imagine seeing nothing for 30 years but people with a skin rash. They have a midlife crisis, and that's when they take to interfering in day-to-day operational management decisions and implementation.

What can you do?
Give them a parallel challenge. Without that, they'll continue to foster deterioration in the Center. Encourage providers facing a midlife crisis to apply their skills in a parallel challenge.

Next Post: Critical Thinking for Community Health Center Governing Boards and Senior Managers

The Danger of Charisma - Thoughts on Community Health Center Governing Boards and Executive Directors

The Danger of Charisma - Thoughts on Community Health Center Governing Boards and Executive Directors

There is too much talk, too much emphasis on leadership today, and not enough on effectiveness.

Leaders
The only thing you can say about a leader is that a leader is somebody who has followers.


An Effective Leader
If an effective Executive Director says "no", it is "no"; and "yes", it is "yes".

Do not say "no" to one person and "yes" to the next one on the same issue.

The most effective Executive Directors know exactly what they can do and what they can not do.

Next Post: - How to Reinvigorate People - Thoughts on Community Health Center Governing Boards and Executive Directors

How Capable Leaders Blow It - Thoughts on Community Health Center Governing Boards and Executive Directors

How Capable Leaders Blow It - Thoughts on Community Health Center Governing Boards and Executive Directors

One of the ablest Executive Director’s I have worked with had an incredible ability to see the heart of a problem. But he was very weak on financial matters. He should have delegated, but he wasted endless hours on budgets and performed poorly.

Never try to be an expert if you are not.

Build on your strengths, and find strong people to do the other necessary tasks.

Next Post: The Danger of Charisma - Thoughts on Community Health Center Governing Boards and Executive Directors

The Transition from Manager to Executive Director - Thoughts on Community Health Center Governing Boards and Executive Directors

The Transition from Manager to Executive Director - Thoughts on Community Health Center Governing Boards and Executive Directors

Let's start out discussing what not to do.

Don't try to be somebody else. By now you have your style. Use your own style to get things done.

Don't take on things you don't believe in, and that you are not good at.

Learn to say "no".

Effective leaders match the objective needs of their company with their own subjective competencies. As a result, they get an enormous amount done fast.

Next Post: How Capable Leaders Blow It - Thoughts on Community Health Center Governing Boards and Executive Directors

How Community Health Centers Fall Down - Thoughts on Community Health Center Governing Boards and Executive Directors

How Community Health Centers Fall Down - Thoughts on Community Health Center Governing Boards and Executive Directors

Make sure the people with whom you work understand your priorities. Community Health Center staff fall down when they have to guess what the boss is working at; and they invariably guess wrong.

The Executive Director needs to say, "This is what I am focusing on."

Then the Executive Director needs to ask the associates,
"What are you focusing on?"

Ask your associates,
"You put this item at the top of your priority list--why?"

The reason may be the right one, but it may also be that this associate of yours is a salesman who persuades you that his priorities are correct, when, in fact, they are not.

Make sure that you understand your associates' priorities.

Make sure that after you have that conversation, you sit down and e-mail them--"This is what I think we discussed. This is what I think we decided. This is what I think you committed yourself to within this time frame." Finally, ask them, "What do you expect from me as you seek to achieve your goals?"

Next Post: The Transition from Manager to Executive Director - Thoughts on Community Health Center Governing Boards and Executive Directors

Prisoner of Your Own Organization - Thoughts on Community Health Center Governing Boards and Executive Directors

Prisoner of Your Own Organization - Thoughts on Community Health Center Governing Boards and Executive Directors

When you are the Community Health Center Executive Director, you're the prisoner of your organization. The moment you're in the office, everybody comes to you and wants something, and it is useless to lock the door. They'll break in.

You have to get outside the office.

Ask the question, "What needs to be done?" Develop your priorities and don't have more than two. No one can do three things at the same time, and do them well. Do one task at a time or two tasks at a time. Two works better for most.

When you are finished with two jobs or reach the point where it's futile, make the list again. Don't go back to priority three. At that point, it's obsolete.

Next Post: How Community Health Centers Fall Down -Thoughts on Community Health Center Governing Boards and Executive Directors

Creative Abandonment - Thoughts on Community Health Center Governing Boards and Executive Directors

Creative Abandonment - Thoughts on Community Health Center Governing Boards and Executive Directors

A critical question for Community Health Center (CHC) leaders is, "When to stop pouring resources into things that have achieved their purpose?"

The most dangerous traps for CHC Governing Boards and Executive Directors
are those near-successes - where everybody says that if you just give it another big push, it will go over the top. They try it once; they try it twice; then a third time. By then it should be obvious this will be very hard to do.

Community Health Center Governing Boards should advise their Executive Directors:
"Tell me what you're doing; and
Tell me what you have stopped doing."

Next Post: Prisoner of Your Own Organization - Thoughts on Community Health Center Governing Boards and Executive Directors

Mission Driven - Thoughts on Community Health Center Governing Boards and Executive Directors

Mission Driven - Thoughts on Community Health Center Governing Boards and Executive Directors

Community Health Center (CHC) leaders need to communicate so people around them know what they are trying to do. They are purpose driven-- mission driven. They know how to establish a mission.

They know how to say “no”.

The pressure on leaders to do a million different things is unbearable; the effective ones learn how to say no and stick with it. They don't suffocate themselves as a result.

Too many Community Health Center Executive Directors and Governing Boards try to do a little bit of 25 things, and get nothing done. They are very popular because they always say “yes”. But they get nothing done.

Next Post: Creative Abandonment - Thoughts on Community Health Center Governing Boards and Executive Directors

Check Your Performance - Thoughts on Community Health Center Governing Boards and Executive Directors

Check Your Performance - Thoughts on Community Health Center Governing Boards and Executive Directors

Effective leaders check their performance. They write down, "What do I hope to achieve if I take on this assignment?" They come back and check their performance against goals.

This way, they find out what they do well and what they do poorly. They also find out whether they picked the truly important things to do.

There are a great many Executive Directors who are exceedingly good at execution, but exceedingly poor at picking the important things. They and their Governing Boards are magnificent at getting the unimportant things done. They have an impressive record of achievement on trivial matters.

Next post: Mission Driven - Thoughts on community health center Governing Boards and Executive Directors

Successful Governing Boards Make Sure That They Succeed:

Successful Governing Boards Make Sure That They Succeed

Successful leaders do not start by asking,
"What do I want to do?"

They ask,
"What needs to be done?"
Then they ask, "Of those things that would make a difference, which are right for me?"

They don't tackle things they aren't good at. They make sure other necessities get done, but not by them. Successful leaders make sure that they succeed! They are not afraid of strength in others.

Next post: Check Your Performance - Thoughts on Community Health Center Governing Boards and Executive Directors

Thoughts on Community Health Center Boards and Executive Directors

Thoughts on Community Health Center Boards and Executive Directors

Traits of Successful Governing Boards:

Successful Governing Boards:
Make sure that they succeed
Check their performance
Are mission driven
Practice creative abandonment
Are not prisoners of their organization
Know how community health centers fail
Successfully navigate the transition from manager to executive director
Know how capable leaders blow it
Are aware of the danger of charisma
Reinvigorate people
Practice character development

Next post: Thoughts on community health center Governing Boards and Executive Directors - Successful leaders make sure that they succeed!

Community Health Centers –Governing Boards That Do Their Job – Part 2 -

Community Health Centers –Governing Boards That Do Their Job – Part 2 -
Strengthening Community Health Center Governing Boards

In our prior post we discussed:
We have a right to expect more from governing boards of community health centers. The system of checks and balances between governing boards and executive teams has, in too many cases, disintegrated. We are seeing that many governing board members are demonstrably unqualified, abjectly remiss, or simply too cozy with their executive directors.

Clearly, we must strengthen these governing boards.

Some measures must include:
Splitting the role of chairman and executive director;
Eliminating "staggered" boards, which allow for only a minority of members to be elected in any one year; and
Giving stakeholders the right to propose board members and resolutions.


Nonexecutive Governing Board Members

Nonexecutive community health center governing board members are in a legal fiduciary relationship to stakeholders and patients.

Community Health Center governing boards have a fiduciary responsibility to oversee management. The governing board chairman is the stakeholder’s main, and, ofttimes sole, visible, representative.

Chairman and Executive Director – Too Close?

How can the chairman oversee the Executive Director, if they are so close personally and so dependent upon each other, that, in effect, their job is one and the same? Splitting the Chairman’s roles into an Operational Chairman and a Finance Chairman would eliminate this inherent conflict.

Similarly, how can stakeholders exercise greater power if senior management is allowed to prevent them from being nominated to company boards? The provisions such as staggered boards, which are meant to prevent a full governing board takeover in any one year is an example.

Often, the very well-compensated and over-perked (despite their protestations to the contrary) -- executive management and governing boards got themselves into this mess. The US Department of Health and Human Services - Bureau of Primary Health Care needs to respond by making lasting changes to make them more accountable to stakeholders, which includes, not only patients and the unserved, but also everyone in this country. http://bphc.hrsa.gov

Corporate Law

Corporate law is largely the province of states, which to varying degrees protect flawed governance models. What is needed is an active Bureau of Primary Health Care (BPHC) that gives stakeholders the right to vote by simple majority to move their community health center’s legal incorporation to states that uphold greater stakeholder rights.

A state recognized as having the most shareholder-friendly corporate laws in the nation, should be selected. By incorporating in that state, and adopting its provisions, a public company would in one easy step improve rights for its shareholders, and eliminate the often too-cozy relations between senior management and the governing board. http://economix.blogs.nytimes.com/author/uwe-e-reinhardt/

Demand Answers

It's fair to ask whether the governing boards demanded answers from their current Executive Directors, about the risks they have taken, and the patients they have not served. Alarm bells should have gone off with the BPHC and the CHC governing boards long ago.

It is high time for taxpayers, stakeholders, and the Bureau of Primary Health Care to demand and receive more accountability from the community health center governing boards and senior management.

Next post: Community Health Centers – More on Governing Boards.

Community Health Centers –Governing Boards That Do Their Job – Part 1.

Community Health Centers –Governing Boards That Do Their Job – Part 1.

This next series of posts will address Community Health Centers –Governing Boards –

The entirely preventable failure of Community Health Center Governing Boards to guide their centers and executive directors to fulfill the dictate to serve the underserved that has unfolded has many culprits:

§ Reckless executive directors who gambled with their center’s futures,
§ Unmotivated federal regulators, and
§ Financially clueless governing boards.

But while senior managers and government regulators have justifiably taken heat for this multifaceted debacle, governing board members have largely been let off the hook. Why?

It is a community health center’s governing board's responsibility to oversee management and to ensure the center’s long-term survival. Its job, in short, is to represent the stakeholders, i.e., the patients, and the unserved low-income members of the community.

With the tumbling and collapse of dozens of medical groups and the underfunding of Medicaid, can we draw any conclusion other than that those governing directors utterly failed in this regard?

Increasingly, we hear apologists rise to the defense of governing boards, evidence that the process of obfuscation of the boards' guilt has begun. This is dangerous.

Nonexecutive governing board directors could not have been expected to understand the risks of complex, highly leveraged accounts receivable accounting during this crisis, the apologists have stated. That is nonsense.

A governing board member should be able to understand when a community health center is stating its accounts receivables that are over 180 days old as revenue, as some do. In my view, many community health center governing boards are not doing their jobs.

Apologists believe that some governing board members should have pressed senior management more on their accounting strategies. Chances are that some directors did take this approach. But did they demand any senior management behavioral change of course? Or did they just accept the management line that certain accounting strategies are necessary?

We have a right to expect more from governing boards of community health centers. The system of checks and balances between governing boards and executive teams has, in too many cases, disintegrated. We are seeing that many governing board members are demonstrably unqualified, abjectly remiss, or simply too cozy with their executive directors.

Next post: Community Health Centers –Governing Boards That Do Their Job – Part 2 - Strengthening Community Health Center Governing Boards.

The Unlearned Lessons of Failing Community Health Centers – Part 4 -

The Unlearned Lessons of Failing Community Health Centers – Part 4 -

The failure of executive directors to believe, despite their mission, and demonstrate through measurable behaviors, that Community Health Centers are established to serve all the medically underserved in its area -

As we continue to address Community Health Centers’ central role in providing primary health care to the unemployed, underemployed, and part-time employed who are uninsured or underinsured.

The way this can be dealt with immediately is through local Community Health Centers that are well-led, well-managed, and well-financed.

If Community Health Centers (CHCs) are vital to resolving the health crisis, what can Community Health Center Board members do to help their Center?

Our sense is that Boards can insist that their Executive Director immediately overcome the following four issues:

1. The lack of transparency.
2. The evolution of community health center financial statements into a dark art.
3. Financial statements as fairytales.
4. The failure of the executive director to believe, despite their mission, and demonstrate through measurable behaviors, that CHCs are established to serve all the medically underserved in its area.

Yesterday we discussed: 3. Financial Statements as Fairytales – Financial Statements that have a somewhat flexible relationship with reality.

Today we address:

4. The failure of executive directors to believe, despite their mission, and demonstrate through measureable behaviors, that CHCs are established to serve all the medically underserved in its area -

Examples:
§ If the Community Health Centers’ Board and Executive Director’s lack behaviorally-demonstrated knowledge of the number of uninsured, underinsured, 100%, 200%, and 300% of poverty level people in your area.

§ If there is a lack of comparative monthly reporting of progress toward the goal of expanding to 100% service in that Centers’ service area. http://bphc.hrsa.gov/policy/pin9823/

§ If your Board members demonstrate a tendency to focus on areas other than increasing patient base and growing visits per day.

§ If you have an Executive Director who has failed to present an effective business model for serving as many of the medically underserved as possible.

§ If your CHC has failed to secure the funds, through direct Medicaid, etc. billing and timely reimbursement, to serve the medically underserved today and tomorrow.

§ If the real growth for the Center consists almost solely of new providers or new lines of business.

§ If the CHC’s new providers and lines of business grow, but established providers have not increased their patient base and visits per day.

Questions to ask
§ Have your established providers increased their patient base and visits per day?

§ Have the CHCs patient encounters per day and per provider increased this year? This quarter?

§ Have the patient-service reimbursements increased?

§ Is the CHC still reliant on periodic grants, or, worse yet, loans?

If any of these issues make you uneasy or defensive, then, as a Board member or Senior Manager, your fiduciary responsibilities need to be exercised toward expanding direct care medical services to the medically underserved in your area.

Next post: Community Health Centers –Governing Boards That Do Their Job

The Unlearned Lessons of Failing Community Health Centers –

The Unlearned Lessons of Failing Community Health Centers –
Part 3: Financial Statements as Fairytales – Financial Statements that have a somewhat flexible relationship with reality -

Community Health Centers’ central role in providing primary health care to the unemployed, underemployed, and part-time employed (who are uninsured or underinsured) is seriously underutilized.

The way this can be dealt with immediately is through local Community Health Centers that are well-led, well-managed, and well-financed.

If Community Health Centers are vital to resolving the health crisis, what can Community Health Center Board members do to help their Center?

Our sense is that Boards can insist that their Executive Director immediately overcome the following four issues:

1. The lack of transparency.
2. The evolution of community health center financial statements into a dark art.
3. Financial statements as fairytales.
4. The failure of the executive director to believe, despite their mission, and demonstrate through measurable behaviors, that CHCs are established to serve all the medically underserved in its area.

In a prior post we discussed: 2. The Evolution of CHC Financial Statements into a Dark Art.

Today we address:

3. Financial Statements as Fairytales – Financial Statements that have a somewhat flexible relationship with reality -

Examples:
Holding account receivables aging on the Revenue side of the Balance Sheet past ca. 90 days (not marked to collection reality, but marked to myth).

Account receivables not being reported at their true worth (monetary value).

Failure to consistently question costs, billings, collections.

Executive Directors repeatedly signing-of on financial statements to the Board that have a somewhat flexible relationship with reality.

Questions to ask
Do the Board and ED understand that accounting is supposed to allow them to see clearly what their CHC is worth financially?

Do the financial statements make the CHCs finances more transparent?

Do the financial statements make the CHCs finances cloudier?

Is the CHCs Accounts Receivable aging marked to collection-reality or marked to myth? (How much can actually be collected from A/R that is over 90-180 days uncollected?)

· Can a quorum of the Community Health Center Board, the Executive Director, and the CFO, clearly and in outline form, explain these issues:
o Key financial terms: assets, liabilities, capital, depreciation, current ratio?
o The CHC in terms of dollars and cents decision options?
o Basic accounting principles?
o How the balance sheet can be used to examine assets and liabilities?How an income statement is used to assess revenues and expenses?
o Cash Flow statements sources and uses of funds?
o Cash flow statements: where cash comes from and how it is applied?
o If not, can any of them respond to how they comply with the PIN 98-23 requirement of Governing Board function and responsibilities requirement (III - Governance):

3. Governing Board Functions and Responsibilities.
The governing board of a health center provides leadership
and guidance in support of the health center’s mission. The
board is legally responsible for ensuring that the health center is operating in accordance with applicable federal, state and local laws and regulations and is financially viable.

b. Responsibilities
A governing board is responsible for assuring that the
health center survives in its marketplace while it pursues its
mission. This is a massive challenge in an extremely dynamic
health care environment which is placing increasing financial and service delivery pressures on all providers. Boards must be knowledgeable about marketplace trends and be willing to adapt their policies and position to reflect these trends. In addition to approving annual grant applications, plans, and budgets, boards should work with health center management and community leaders to actively engage in long-term strategic planning to
position the health center for the future.

Success is dependent on the health center’s ability to
effectively adapt to marketplace trends while remaining
financially viable…
ftp://ftp.hrsa.gov/bphc/docs/1998pins/PIN98-23.PDF

Where does your Community Health Center fit into this fiduciary continuum?

How can you be sure?

What are the measurements you use?

What are your criteria for effectiveness?

Did the answer you just gave include both the medically served and unserved people in your community?

If not, why not?

Next post: The Unlearned Lessons of Failing Community Health Centers –
Part 4 - The failure of executive directors to believe, despite their mission, and demonstrate through measurable behaviors, that CHCs are established to serve all the medically underserved in its area -

Posting Notice

Posting Notice

The Unlearned Lessons of Failing Community Health Centers –
Part 3 - Financial Statements as Fairytales
(Financial Statements that have a somewhat flexible relationship with reality) - will be posted on Monday, March 2, 2009.

Next post: The Unlearned Lessons of Failing Community Health Centers – Part 3 - Financial Statements as Fairytales …

The Unlearned Lessons of Failing Community Health Centers – Part 2

The Unlearned Lessons of Failing Community Health Centers – Part 2
The Evolution of CHC Financial Statements into a Dark Art –

As we continue to address Community Health Centers’ central role in providing primary health care to the unemployed, underemployed, and part-time employed who are uninsured or underinsured, we need to stay alert to these issues:

Healthcare in America is not a looming crisis.
It is not a pending catastrophe.
American healthcare is in a state of crisis now.

Healthcare for the uninsured and underinsured is a dark waltz with disaster.

The way this can be dealt with immediately is through local Community Health Centers that are well-led, well-managed, and well-financed.

If Community Health Centers are vital to resolving the health crisis, what can Community Health Center Board members do to help their Center?

Our sense is that Boards can insist that their Executive Director immediately overcome the following four issues:

1. The lack of transparency.
2. The evolution of community health center financial statements into a dark art.
3. Financial statements as fairytales.
4. The failure of the executive director to believe, despite their mission, and demonstrate through measurable behaviors, that CHCs are established to serve all the medically underserved in its area.

Yesterday we discussed: 1. The Lack of Transparency.

Today we address:

2. The Evolution of CHC Financial Statements into a Dark Art –

Examples:
§ Consecutive monthly Board meetings without a substantive discussion of:
1. Accounts Receivables (A/R) and A/R aging

2. The Executive Director’s report on what the community health center is currently doing

3. The Board questioning the Executive Director on what the center has stopped doing

§ The monthly financial statements submitted to the Centers’ Board consistently report a steady and smooth growth.

Questions to ask
Can the Board and ED understand the complexity of its financial statements?

Can they articulate the complexity of the CHC financial structure?

Can they articulate the CHC’s current debt, debt service, and payments?

Do the Executive Director and Chief Financial Officer “manage” the centers’ reported income and liabilities on the financial statements?

Next post: The Unlearned Lessons of Failing Community Health Centers –
Part 3 - Financial Statements as Fairytales – Financial Statements that have a somewhat flexible relationship with reality.

The Unlearned Lessons of Failing Community Health Centers

The Unlearned Lessons of Failing Community Health Centers

As we address Community Health Centers’ central role in providing primary health care to the unemployed, underemployed, and part-time employed who are uninsured or underinsured, we need to stay alert to these issues:

To recap:
Healthcare in America is not a looming crisis.
It is not a pending catastrophe.
American healthcare is in a state of crisis now.

Healthcare for the uninsured and underinsured is a dark waltz with disaster:

From 13 consecutive months of job loss,

To 20,000,000 people unemployed, underemployed, or working part-time,

To 54% of chronically ill giving-up necessary medical care due to lack of money, (http://www.commonwealthfund.org/index.htm

To a 1% increase in unemployment resulting in an increase of 1,000,000 people with no health insurance (Kaiser Family Foundation - http://www.kff.org/ and NewsHour – PBS -HealthBeat -http://www.pbs.org/newshour/indepth_coverage/health/uninsured/index.html

To State Medicaid denials rising - http://www.washingtonpost.com/wp-dyn/content/article/2009/02/11/AR2009021104311.html

To the U.S. economy has shedding more jobs that the total population of Chicago – Heidi Shierholz – Economic Policy Institute - http://www.epi.org/quick_takes/entry/3.5_million_jobs_lost/

If these men, women, and children do not have the money for adequate food, clothing, or shelter, how can we expect that they can afford basic, primary healthcare for pre-natal, early childhood, and chronic diseases?

This can be dealt with immediately through local Community Health Centers that are well-led, well-managed, and well-financed.

If Community Health Centers are vital to resolving the health crisis, what can Community Health Center Board members do to help their Center?

Our sense is that Boards can insist that their Executive Director immediately overcome the following four issues:

1. The lack of transparency.
2. The evolution of community health center financial statements into a dark art.
3. Financial statements as fairytales.
4. The failure of executive directors to believe, despite their mission, and demonstrate through measurable behaviors, that CHCs are established to serve all the medically underserved in its area.

1. The Lack of Transparency –

Examples:
§ An Executive Director who fails to take responsibility for errors.

§ An Executive Director who does not consistently deflect credit onto staff.

§ An Executive Director who understands all of the community health center’s monthly financials.

§ Failure to present monthly financials to the Governing Board – including cash flow statements – in advance of the monthly meeting.

§ Failure to receive accompanying explanations of those monthly financial statements.

§ Failure to receive copies of the annual outside audit with Management Letters – in advance of the monthly meeting.

§ Inability of Executive Director and Board members to understand exactly how their Center makes money (hint: it’s not through grants or loans).

Questions to ask
Are the Board the Senior Managers able to understand and monitor how their CHC makes and spends money?

Can they articulate that understanding?

Can the Board and Senior Managers articulate an understanding of Income and Liabilities in relation to Accounts Receivable (A/R) and A/R aging?

Next Post: The Unlearned Lessons of Failing Community Health Centers – Part 2: The Evolution of CHC Financial Statements into a Dark Art –

Community Health Centers: Leadership – Structure – Finance: The Business Model.

Community Health Centers: Leadership – Structure – Finance: The Business Model.

We continue to address Community Health Centers’ central role in providing primary health care to the unemployed, underemployed, and part-time employed who are uninsured or underinsured.

Healthcare in America is not a looming crisis. It is not a pending catastrophe. American healthcare is in a state of crisis now. As has been outlined in prior posts, healthcare for the uninsured and underinsured is a dark waltz with disaster.

If these (unemployed, underemployed, and part-time employed who are uninsured or underinsured) men and women cannot afford adequate food, clothing, or shelter, then, they certainly cannot afford basic, primary healthcare for pre-natal, early childhood, and chronic diseases.

The way this can be dealt with immediately is through well-led, well-managed, and well-financed, local Community Health Centers.

This post addresses:
Community Health Centers - Leadership, Structure, and Finance: The Business Model.

Healthcare Is Unique

Healthcare is a unique, complex, three-way relationship between:
Patient
Physician
Insurer

The Components Of This Unique System Are:
Patients, who consume services but don't generally pay for the entire cost
of medical services...,

Providers, who not only provide, but also prescribe services, in essence
making the decision to buy on behalf of the patient...,

Payors, who neither provide nor consume medical services.


The Business Model Objective and The Expected Results

To implement an effective business to address the mirror issues of consistent quality care and maximum revenue - with the following results:

Leadership
1. Manage the annual budget, monthly financial reporting, and capital improvement planning processes.
2. Develop and implement financial policies and procedures – Including due diligence reviews.
3. Expand Health Programs from single focus to comprehensive services.
Attain scores of over 96% in 3rd party Payor audits.

Structure
1. Developed a full-service, system-wide MIS Department that implements an EMR/IMS process while increasing visits per day and decreasing costs.
2. Enhance managers’ professional skills of planning, organizing, staffing, directing, and monitoring.

Finance
1. Increase monthly revenue by ____
2. Reduce costs by ____
3. Decrease Internal A/R from ____ days to ____ days.
4. Reduce External A/R from ____ days to ____ days.

The Business Model Implementation

Many Community Health Center Boards and Executive Directors talk a good game of being the best, the soonest, with the most; however, as with most things of importance, the devil is in the implementation.

As has been made clear in many prior posts, many Executive Directors do not know how to implement to attain the objective of serving the medically underserved. For instance:
How much has your Center’s patient base grown in the past year?
How much has your visits per day per provider grown in the last year?
Are you growing, or treading water?
What excuses are you, as a Board member, hearing about this failure to grow in serving the underserved?
Is your lack of knowledge keeping your health center from growing to serve the underserved?
Who is responsible for this failure to grow?
Who is being held responsible for that failure?

The Business Model Questions

Is your Community Health Center functioning in a manner that allows it to serve the maximum number of underserved in its area? … Or,

Is your Center operating at the leisure of the providers? … Or,

Has it been operating as a mere boutique business?

Are your hours set to serve the underserved, or to serve the employees?

Does your Governance Board conduct itself in a fiduciary manner – with all the obligations inherent in that role?

Does your Executive Director have the knowledge, skill, values, manners temperament, and experience necessary to do the job?

Is your financial staff giving you the information your need, or just the information that makes your feel better?

Did you actually read, question, and understand the last outside audit?

Did you raise any questions?

Were those questions answered to your satisfaction?

How deep did you dig into last month’s financial statements?

Next series of posts: The Unlearned Lessons of Failing Community Health Centers –In Four Parts.

Community Health Center Leadership – Structure – Finance: An Overview

Community Health Center Leadership – Structure – Finance: An Overview

In this ongoing series, we address Community Health Centers (CHC) and their central role in providing primary health care to the unemployed, underemployed, and part-time employed who are uninsured or underinsured.

Healthcare in America is not a looming crisis.
It is not a pending catastrophe.
American healthcare is in a state of crisis now.
With job and health insurance losses, healthcare for the uninsured and underinsured is a dark waltz with disaster.

If people cannot afford adequate food, clothing, or shelter; then, they certainly cannot afford basic, primary healthcare.

The unemployed, underemployed, and part-time employed who are uninsured or underinsured can receive medical services through local Community Health Centers that are well-led, well-managed, and well-financed. The demand for vital, robust, and financially sustainable Community Health Centers is critical. But what is the key foundation for a vital CHC?

This post addresses that issue:

Leadership – Structure – Finance: An Overview

Integrity (defined)

The ability to understand, and convert into action, as their primary task and duty, the foremost need of the organization –
The ability to see the world as it actually, not as they want it to be (which, of course, is vision, which, in some cases, could lead to illusion).

Leadership Integrity, leads to- Structural Integrity - Selecting and adhering to the top four elements, which leads to - Financial Integrity - Selecting and adhering to predictive indicators.

Leadership Integrity:
The ability to see the world as it actually, not as you may want it to be.

Leadership

The ability to see the world as it actually is, not as you pretend it to be.
1. Do they understand, and convert into action, the foremost governance need of the organization as their first and primary task and duty?
2. Are they demagogic (manipulating, obscuring, and/or distorting)?
3. Not just playing well themselves, but helping others play better…

Structural

The ability to see the world as it actually is, not as you pretend it to be.
1. Do they understand, and convert into action, the foremost structural need of the organization as their first and primary task and duty?
2. Effective business vision
3. Focus on value creation (Human Assets, Expertise, Parameters, and Change)
4. Foster internal forces that encourage progress

Financial

The ability to see the world as it actually is, not as you pretend it to be.
Do they understand, and convert into action, the foremost financial need of the organization as their first and primary task and duty?
1. Positive cash flow …
2. Total physician compensation at 45% of net collections …
3. Total medical group expenses at 88% of total net collections …
4. Internal accounts receivable less than 3 days …
5. External accounts receivable less than 46 days …

The Key Issues
1. Do each of these elements: Leadership, Structure, and Financial, have integrity?

2. Do they understand, and convert into action, the foremost need of the organization - as their first and primary task and duty?

3. Do they have, and convert into action, a one-line job description? (The most difficult of tasks)

4. Do they understand, and convert into action self-executing mechanisms?

5. Do they have, and convert into action, their core competencies?

6. Are their core competencies relevant?

7. Are they effective, or merely efficient, or neither?

8. Are they efficacious?

9. Are they muscle, fat, or cancer?

10. Do they staff from strengths or weaknesses?

Next post: Leadership – Structure – Finance: The Business Model.

Reflecting Forward – posting notice

Community Health Center – effective practice management – Our next post will be on Tuesday, February 24, 2009.

Next post: Leadership – Structure – Finance: An Overview

Community Health Centers: The Integrity Structure of Leadership, Structure, and Financial – Introduction to Financial

Community Health Centers: The Integrity Structure of Leadership, Structure, and Financial – Introduction to Financial

In this continuing series, we address Community Health Centers and their central role in providing primary health care to the unemployed, underemployed, and part-time employed who are uninsured or underinsured.

Healthcare in America is not a looming crisis. It is not a pending catastrophe. American healthcare is in a state of crisis now. Healthcare for the uninsured and underinsured is a dark waltz with disaster:

From 54% of chronically ill giving-up necessary medical care due to lack of money, (http://www.commonwealthfund.org/index.htm )

To a 1% increase in unemployment resulting in an increase of 1,000,000 people with no health insurance - Kaiser Family Foundation - http://www.kff.org/ and NewsHour – PBS -HealthBeat -http://www.pbs.org/newshour/indepth_coverage/health/uninsured/index.html

If these men, women, and children cannot afford adequate food, clothing, or shelter; then, they certainly cannot afford basic, primary healthcare for pre-natal, early childhood, and chronic diseases.

The way this can be dealt with immediately is through local Community Health Centers. However, until Community Health Centers (CHCs) are well-led, well-managed, and well-financed, they will not be in a consistent position to serve the medically underserved. The demand for vital, robust, and financially sustainable Community Health Centers is central to the health of this nation.

This post addresses:
The Integrity Structure of Leadership, Structure, and Finance – Introduction to Financial

Financial
Does the leadership understand, and convert into action, the foremost financial need of the organization as their first and primary task and duty?

1. Positive cash flow …
2. Total provider compensation at 45% of that provider’s net collections …
3. Total medical CHC expenses at 88% of total net collections …
4. Internal accounts receivable of less than 3 days …
5. External accounts receivable of less than 46 days …

Next post: Leadership – Structure – Finance: An Overview

The Integrity Structure of Leadership, Structure, and Finance – Introduction to Structure

The Integrity Structure of Leadership, Structure, and Finance – Introduction to Structure

Continuing in this series, we address Community Health Centers and their central role in providing primary health care to the unemployed, underemployed, and part-time employed who are uninsured or underinsured.

Healthcare in America is not a looming crisis. It is not a pending catastrophe. American healthcare is in a state of crisis now. Healthcare for the uninsured and underinsured is a dark waltz with disaster:

From 13 consecutive months of job loss,

To 20,000,000 people unemployed, underemployed, or working part-time,

If these men, women, and children cannot afford adequate food, clothing, or shelter, then, they certainly cannot afford basic, primary healthcare for pre-natal, early childhood, and chronic diseases.

The way this can be dealt with immediately is through local Community Health Centers. However, until Community Health Centers (CHCs) are well-led, well-managed, and well-financed, they will not be in a consistent position to serve the medically underserved. The demand for vital, robust, and financially sustainable Community Health Centers is central to the health of this nation.

This post addresses:
The Integrity Structure of Leadership, Structure, and Finance – Introduction to Structure

Structure
Does the leadership understand, and convert into action, as their first and primary task and duty, the foremost structural need of the organization?

1. Effective business vision
2. Focus on value creation (Human Assets, Expertise, Parameters, Change)
3. Foster internal forces that encourage progress - [or, Are they demagogic?]

Next post: The Integrity Structure of Leadership, Structure, and Finance – Introduction to Financial

Community Health Centers: Leadership Integrity

Community Health Centers: Leadership Integrity

In this series, we continue to write about Community Health Centers and their central role in providing primary health care to the unemployed, underemployed, and part-time employed who are uninsured or underinsured.

Healthcare in America is not a looming crisis. It is not a pending catastrophe. American healthcare is in a state of crisis now. Healthcare for the uninsured and underinsured is a dark waltz with disaster:

From 13 consecutive months of job loss,

To 20,000,000 people unemployed, underemployed, or working part-time,

If these men, women, and children cannot afford adequate food, clothing, or shelter, then, they certainly cannot afford basic, primary healthcare for pre-natal, early childhood, and chronic diseases.

The way this can be dealt with immediately is through local Community Health Centers.

However, until Community Health Centers (CHCs) are well-led, well-managed, and well-financed, they will not be in a consistent position to serve the medically underserved.

This post will address:
Community Health Centers: Leadership Integrity

INTEGRITY (defined) – The ability to understand, and convert into action, as the leader’s first task and duty, the foremost need of the organization.

Do your leaders have the ability to see the world as it actually, not as they want it to be (which, of course, is vision, unfortunately, at this stage of development, vision may lead to illusion – a subject of future postings).

Leadership – Structure – Financial

Leadership Integrity, leads to - Structural Integrity - Selecting and adhering to the top four elements (Human Assets, Expertise, Parameters, Change) which leads to - Financial Integrity ( Selecting and adhering to effective predictive/leading financial indicators).

The Key Issue:
Do these elements have integrity?
1. Leadership,
2. Structure, and
3. Financial.

The Leadership Questions

What are the Board’s assumptions about their Executive Director and Senior Managers?

Are their assumptions premised upon:
The Lone Ranger theory of management?
That the supply of talented executives is strictly limited?

Do they understand, and convert into action self-executing mechanisms?

Do they have, and convert into action, their core competencies?

1. Are their core competencies relevant?
2. Are they effective, or merely efficient, or neither?
3. Are they muscle, fat, or cancer?
4. Do they staff from strengths or weaknesses?
5. Do they have, and convert into action, a one-line job description?
6. Do they not just playing well themselves, but help others play better?

Next post: The Integrity Structure of Leadership, Structure, and Finance – Introduction to Structure

The Community Health Center Integrity Structure of Leadership, Structure, and Finance – An Introduction – Reflecting Forward

Reflecting Forward
Effective Practice Management for Community Health Centers

In this series, we will write about Community Health Centers and their central role in providing primary health care to the unemployed, underemployed, and part-time employed who are uninsured or underinsured.

This post addresses:
The Community Health Center Integrity Structure of Leadership, Structure, and Finance – An Introduction – Reflecting Forward

Not a Looming Crisis?

Healthcare in America is not a looming crisis. It is not a pending catastrophe. American healthcare is in a state of crisis now. Healthcare for the uninsured and underinsured is a dark waltz with disaster:

From 13 consecutive months of job loss,

To 20,000,000 people unemployed, underemployed, or working part-time,

To 54% of chronically ill giving-up necessary medical care due to lack of money, (http://www.commonwealthfund.org/index.htm

To a 1% increase in unemployment resulting in an increase of 1,000,000 people with no health insurance (Kaiser Family Foundation - http://www.kff.org/ and NewsHour – PBS -HealthBeat -http://www.pbs.org/newshour/indepth_coverage/health/uninsured/index.html )

To State Medicaid denials rising - http://www.washingtonpost.com/wp-dyn/content/article/2009/02/11/AR2009021104311.html

To the U.S. economy has shedding more jobs that the total population of Chicago – Heidi Shierholz – Economic Policy Institute - http://www.epi.org/quick_takes/entry/3.5_million_jobs_lost/

If these men, women, and children cannot afford adequate food, clothing, or shelter, then, they certainly cannot afford basic, primary healthcare for pre-natal, early childhood, and chronic diseases.

Community Health Centers and Universal Healthcare

While universal health care may be the ideal, until, and if, it is enacted (with full coverage), properly and permanently funded (unlike Medicaid), and effectively implemented (with evergreen clauses), those 20,000,000 men and women will continue to suffer needlessly, and so will this country.

The way this can be dealt with immediately is through local Community Health Centers. However, until Community Health Centers (CHCs) are well-led, well-managed, and well-financed, they will not be in a consistent position to serve the medically underserved. The demand for vital, robust, and financially sustainable Community Health Centers is central to the health of this nation.

Central Questions

Who can ensure that the Community Health Centers are well-led?

Who has the ability to take these steps?

What do they need to do?

What steps will they need to take?

When can this begin?

Where will this be implemented?


How can CHCs overcome this seemingly permanent problem of sub-par medical management and paltry funding?

Are the current leaders able to do the job?

Do they have the knowledge, skills, values, experience, and temperament to do this critical, complicated job?

Are your Community Health Center Board and Executive Director equal to the task?

If so, why hasn’t your community health center’s service to the underserved increased to meet the needs?

What excuses have you been given?

How long have you been hearing those excuses?

Why do you still believe those excuses?



The Who – What – When – Where and How

Future postings in this series will discuss the “who, what, when, where, and how” of the above questions.

This is not an instant gratification process. However, since CHCs have been around for over thirty years, and they are still failing to serve even the majority underserved in their areas, it might be time to pause, read, and reflect on the Who, What, When, Where, and How of serving the underserved.

We will set-forth options, hypothetical case studies of two community health centers, and an outline of an effective business model (Leadership – Structure – Financial) for sustainable Community Health Centers.

Next Post: Community Health Centers: Integrity and Leadership

Effective Practice Management for Community Health Centers - Posting Notice

Effective Practice Management for Community Health Centers - Posting Notice

Effective practice management for community health centers next series of posts will begin on Tuesday, February 17, 2009. Because of the breadth of the series, The Community Health Center Integrity Structure Of Leadership, Structure, and Finance, we will need the additional three days to edit (yes, edit…) the material for precision.

The new series will start on Tuesday…

Next post: The Community Health Center Integrity Structure of Leadership, Structure, and Finance – An Introduction – Reflecting Forward: Effective Practice Management for Community Health Centers

A Profile of Community Health Centers Errors

A Profile of Community Health Centers Errors

Part 1
A. Failing to define effectively, realistically, and concisely the mission and purpose of the CHC.
B. Weak providers as the cornerstone.
C. Not viewing the organization as a relationship among equals with each party bringing something of value to the table.
D. Not having equal, one-man-one-vote, governance.
E. Ineffective quality control and outcomes review procedures
F. Lack of a patient education program

Part 2
A. Not hiring an operationally strong and experienced Executive Director.
C. Failing to implement and administer business systems and procedures.
D. A poor, or absent, marketing plan
E. Weak financial management
F. Limited business vision
G. No legal document
H. No concise, viable mission statement.

Part 3
A. Expecting the CHC to handle work without getting paid.
B. Not being committed to serving the underserved as a serious business relationship.
C. Giving the CHC tasks that are not consistent with its mission.

Part 4
A. Choosing an inappropriate computer system and software.
B. Using more than one computer system in the initial model.
C. An inadequate management information system (one that was state of the art when color television was a novelty).

As Community Health Center Boards and Senior Managers, if these mistakes are occurring, and recurring within your CHC, consider reading and addressing the next series of posts: The Community Health Center Integrity Structure of Leadership, Structure, and Finance.

Next post: The Community Health Center Integrity Structure of Leadership, Structure, and Finance.

The Major Mistakes Community Health Centers Make – Mistakes 4, 5, and 6.

The Major Mistakes Community Health Centers Make – Mistakes 4, 5, and 6.

Continuing with this Series, yesterday we wrote about the first three mistakes:
1. Failing to Define the Mission and Purpose of the Community Health Center
(CHC)
2. Giving the Community Health Center Tasks That Are Not Consistent With Its
Mission
3. Running a Community Health Center Using Weak Providers

The potential for the success of a Community Health Center is great; however, the track records of many CHC’s are littered with mistakes, failures, and attempts to repeat the same historic actions while expecting different results. This series is designed to help your Community Health Center avoid repeating prior CHC failures:

a. Failure to serve the medically underserved in its area;
b. Failure to its employees in not having competent senior management;
c. Failure to use its resources effectively.

Mistake # 4. community health centers not hiring an operationally strong Executive Director:
Community Health Center Boards are often eager to hire “heavyweights” to run their operation. However, that heavyweight may not have sufficient top-level management experience, and little understanding of the operating basics that are critical in a CHC. Community Health Center Executive Directors must demonstrate that they can run the CHC more effectively than the physicians or the office managers.

Mistake # 5. Expecting the community health center to handle work without getting paid:
If the CHC Boards and Senior Management require work to be done, they must ensure that their CHC is paid the fair-market-value for that work. If the CHC is asked to perform a task free of charge, or even at a reduced rate, it will lose money. This loss of money will impact its ability to continuing serving the underserved.

Mistake # 6. Choosing an inappropriate computer system and software:
Vendors will tell you that their system is perfect for your needs, and that their system can do anything. Because of the lack of experience or knowledge in selecting a system for a CHC, Senior Management may find itself with a system that cannot track accounts receivables, managed care patients, file claims electronically, handle authorizations, or facilitate accurate and timely patient and operational data.

Some CHCs take shortcuts because of tight budgets. They may continue using their old, outdated, sometimes cheap systems. As a result, there is no appreciable impact on the operation of the community health center and its patients. Patients suffer, when CHCs use computer systems and programs that were new when color television was a novelty.

Next Post: A Profile of Community Health Centers Errors

Addressing the Major Mistakes Community Health Centers Make – Mistakes 1, 2, and 3

Addressing the Major Mistakes Community Health Centers Make – Mistakes 1, 2, and 3

The potential for the success of a Community Health Center (CHC) is great; however, the track records of many Community Health Centers are littered with mistakes, failures, and attempts to repeat the same historic actions while expecting different results. This series is designed to help your Community Health Center avoid repeating the consequences of prior CHC failures:

a. Failure to serve the medically underserved in its area;
b. Failure to its employees by not having competent senior management;
c. Failure to use its resources effectively.

Mistake # 1. Failing to define the mission and purpose of the community health center (CHC):
It is important that the CHC’s mission and purpose be defined and shared with all involved parties and departments. This helps keep everyone focused. What business is your CHC really in? Is it medical services? Is it grant writing? Is it providing experience for new medical graduates? Is it serving the medically underserved? Do you, as a Board member, know what business your CHC is really in?

Mistake # 2. Giving The Community Health Center Tasks That Are Not Consistent With Its Mission:
The CHC should not become involved with projects that deviate from its established mission and purpose of serving the medically underserved. Evaluate work requests to insure that they are in keeping with the CHC’s purpose and goals.

Mistake # 3. Running a community health center using weak providers
The CHC’s gain their strengths through patient encounters, centralized systems, and experienced staff. Weak providers cannot financially support a CHC operation. These underfinanced CHCs with weak providers waste their employees’ talents by pushing them to be “jacks-of-all-trades” who do not have sufficient experience to effectively staff a heavily-used CHC operation.

Next post: The Major Mistakes Community Health Centers Make –
Mistakes 4, 5, and 6

A SERIES SUMMARY: The Single, Tragic, Yet Avoidable, Mistake Made By Community Health Center Boards:

A SERIES SUMMARY: The Single, Tragic, Yet Avoidable, Mistake Made By Community Health Center Boards:

1. Failing to Hire an Operationally Strong Executive Director.

This single, tragic mistake, and this mistake alone, is not only the Board’s biggest mistake, but also it will lead to:

The Major Errors

a. Failing to define the mission and purpose of the Community Health Center
(CHC).
b. Giving the CHC tasks that are not consistent with its mission.
c. CHCs using weak providers as its cornerstone.
d. Ineffective finances and financials.
e. Over-reliance on consultants.
f. Failure to develop management staff.
g. Expecting the CHC to handle work without getting paid.
h. Choosing an inappropriate computer system and software.
i. Maintaining the status quo.

If these sound familiar, read on.

If they sound painfully familiar, you may want to re-read this series. http://effectivepracticemanagement.blogspot.com/2009/01/report.html

An effective community health center executive director does not need to be a stereotypical leader in the sense that the term is now used. As Peter Drucker outlined in “What Makes and Effective Executive”, leaders are all over the map in terms of personality, attitude, values, strengths, and weaknesses.

The Eight Practices

What makes community health center executive directors effective is that they follow these eight practices:
1. They ask: what needs to be done?
2. They ask: what is right for the CHC?
3. They develop action plans.
4. They take responsibility for their decisions.
5. They take responsibility for communicating.
6. They focus on opportunities rather than problems.
7. They run productive meetings.
8. They think and say “we” rather that “I”.

Does this sound familiar to the Community Health Center’s Board?
Is this what exists within your community health center’s Executive Director?

If so, you are quite fortunate. If not, I hope that this series of posts has helped your community health center to serve its medically underserved patients.

Next post: ADDRESSING THE MAJOR MISTAKES COMMUNITY HEALTH CENTERS MAKE – Mistakes 1, 2, and 3

COMMUNITY HEALTH CENTERS – The Final Practice: Think and Say “We”.

COMMUNITY HEALTH CENTERS – The Final Practice: Think and Say “We”.

Yesterday we reviewed the practice of an effective Community Health Center Executive Director in Making Meetings Productive. Now, let’s review the practice of Thinking and Saying “We”.

Don’t Say “I” – Say “We”

The final practice is: Do not think and say “I”. Think and say “we”. Effective Community Health Center Executive Directors know that they have ultimate responsibility, which can be neither shared nor delegated. They are also acutely aware that they have that authority, because, and only because, they have the trust of the organization.

Think of Needs and Opportunities

The truly effective Community Health Center Executive Directors think of the needs and the opportunities of their center before they think of their own needs and opportunities. This sounds simple; it is not. It is the one practice that is rarely observed.

Effectiveness Is a Discipline

Effective Community Health Center Executive Directors differ widely in personality, strengths, weaknesses, values, skills, and beliefs. All they have in common is that they get things done.

Effectiveness is a discipline. And, as a discipline, it can be learned. Once learned, and consistently practiced, by your Executive Director, it will benefit your Community Health Center and its medically underserved patients immeasurably.

Next post: COMMUNITY HEALTH CENTERS – A Series Summary

COMMUNITY HEALTH CENTERS – Taking Action - The Fourth Practice – d. Making Meetings Productive

COMMUNITY HEALTH CENTERS – Taking Action - The Fourth Practice – d. Making Meetings Productive

Yesterday we reviewed the practice of an effective community health center Executive Director in Focusing on Opportunities. Today, we’ll review the practice of Making Meetings Productive:

Every Community Health Center executive, senior manager, and most junior managers spend more than half of each day in meetings. Even a conversation with one other person is a meeting. If Community Health Centers are to be effective, they must make their meetings consistently productive.

What Kind Of Meeting Is It?

The key to running an effective meeting is to decide in advance what kind of meeting it will be. Different meetings require different forms of preparation and different results:

1. A Meeting to Prepare a Statement.
One member has to prepare a draft in advance. At meeting’s end, a pre-appointed member has to take responsibility for disseminating the final text.

2. A Meeting to Make an Announcement.
This meeting is confined to the announcement and a discussion about it.

3. A Meeting in Which One Member Reports.
Nothing but the report needs to be discussed.

4. A Meeting in Which Several or All Members Report.
Either no discussion at all, or limited to questions for clarification. The reports should be distributed before the meeting. Each report is limited to 10 minutes.

5. A Meeting to Inform the Convening Executive.
That executive should listen, ask questions, then sum up; but not make a presentation.

6. A Meeting Whose Function Is to Allow the Participants to be in the Executive Director’s Presence.
There is no way to make these meetings productive. You must sit still, make the appropriate noises, and hope you don’t fall asleep.

Productive Meetings

Productive meetings require self-discipline. They require thinking through the purpose of the meeting, and sticking to the format. It is mandatory to terminate the meeting as soon as its purpose is accomplished. Effective Executive Directors do not raise another matter for discussion. They make sure that the meetings are work sessions, and not gossip sessions. They sum up and adjourn. They also practice good follow-up.

Effective Community Health Center Executive Directors know that any given meeting is either productive or a total waste of time.

Next post: COMMUNITY HEALTH CENTERS – The Final Practice: Think and Say “We”.