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