THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 1. THE LACK OF URGENCY.

The Deadly Sins of Community Health Centers -Part 1 - The Lack of Urgency

Much discussion has been focused on how community health centers (CHCs) could not only respond to current market forces, but also assist with universal health care. But just as challenging — and less addressed — is the self-inflicted damage that community health centers and their management commit - which poses a serious threat to their financial health, if not their survival.

Questions frequently asked are –

“If CHCs have been around for over 35 years, why are they not serving more underserved people?” (A typical CHC will serve only a small percentage of the underserved in its area.)

Is it lack of direction from the Board of Directors?

Is it a lack of Executive Director skill and competence?

Why are appointment waiting times so long? (Typically over two weeks)

Why are the daily patient schedules of the CHC doctors’ not full?

Before community health centers can compete effectively in the current and future health care environment, we must address the following deadly sins:

1. Lack of urgency
2. Tendency to chase the latest trend
3. Inability to embrace proven management techniques
4. Meaningless networks
5. Resistance to change and denial
6. Hamster wheel as strategy

The Deadly Sins of Community Health Centers - Part 1

1. Lack of urgency
Physicians usually respond quickly to their patients' needs, but community health centers often lack the same sense of urgency in making management decisions.

Businesses ask --

"How do we solve this problem in a way that achieves an advantage for us and our customers?”

“What makes us different?”

Community health centers merely ask --

"What are other community health centers doing?"

It’s dangerous to assume that one center’s unique issues can be addressed by selecting from a smorgasbord of solutions already tried by others. If a community health center cannot distinguish itself from the competition — in the eyes of patients, payers, grantors, and referral sources — then, over time, its patient base will be lost, new patients will not be gained, current patients will drift away, and the Community Health Center will gradually become irrelevant.

Next post: The Deadly Sins of Community Health Centers (continued - Part 2)

WHAT ARE COMMUNITY HEALTH CENTERS? - ARE THEY BEING MANAGED AND LED EFFECTIVELY?

What are Community Health Centers? - Are they being managed and led effectively?

We have worked for many years with Community Health Centers (CHCs). These organizations have had great success addressing the medically underserved in this country. Today we begin a series of postings answering questions, outlining what we have learned while working with these Centers, and making a few suggestions for improvements.

We begin today with a brief outline of Community Health Center (CHC) expectations as stated by the Bureau of Primary Health Care (BPHC) under section 330 of the Public Health Service Act as amended by the Health Centers Consolidation Act of 1996, inter alia,

1. To provide primary and preventive health services to medically underserved populations;

2. To maintain strong leadership, finances and infrastructure in order to adapt and survive the challenges of a transforming health care environment;

3. To deliver high quality clinical services;

4. To ensure that health centers not only survive, but thrive as they move into the twenty-first century.

The CHC Program Expectations include the importance of adapting to health care trends and remaining financially viable, while fulfilling the essential health center mission of providing preventive and primary care services which improve the health of the underserved.

During this critical time for healthcare, it is imperative that we ask these questions:

How well do CHCs follow the above expectations?
How involved are the CHC Boards of Directors?
How skilled are the Executive Directors at ensuring the delivery of care to the underserved?
How committed are the providers (Doctors, Nurse Practitioners, Physician Assistants)?
Are the medically underserved being served?
Is there strong leadership in place?
Is the leadership capable of financial stewardship?
Is the leadership capable of financial strength?
Are the patients being served?

These, and other, questions about Community Health Centers will be addressed in future posts.


Next post: The Deadly Sins of Community Health Centers (Parts 1, 2 & 3)

RULES FOR MANAGING THE PRIMA DONNA

Rules for managing the prima donna:

The prima donna’s job is twofold:
When the playbill says Tosca, sing Tosca; and
Fill the house- every night.

When they fulfill that job consistently, then, and only then, will the effective manager treat them as prima donnas. Otherwise they are merely whiners.

Next series of posts: What are Community Health Centers, and how should they be managed and led?

STAFFING FROM STRENGTHS

Staffing from strengths (Four rules):

Jobs are not created by nature or by God.
(Forever be on guard against the impossible job)

Make each job demanding.
(Jobs must have challenge in them to bring out staff’s strengths)

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)

To get strengths, one has to put up with weaknesses.

Next post: The Rules for Managing the Prima Donna …

MANAGEMENT STAFFING ISSUES

Management staffing issues:

Are they able to do the work? (Do they have the requisite knowledge, skills, values, manners, temperament, and experience?)

Do they know what they are expected to contribute? (Goals, standards, timetables, etc.)

Has the organization taken placement responsibility? (Staffed from strengths; Placement and assignment control; etc.)

Has the organization considered where that person really belongs? (Outplacement)


Next post: Staffing From Strengths (The Four Rules) …

MANAGEMENT ABILITY ISSUES

Management ability issues:

• Knowledge (Do they know it?)

• Skill (Do they do it? - Do they do it effectively?)

• Values (Do they want to be liked or respected?)

• Manners (Do they do it courteously? - Do they disagree without being disagreeable?)

• Temperament (Their manner of thinking, behaving, reacting):
Are they efficient? [Do the thing right]
Are they effective? [Do the right thing]
Are they efficacious? [Get the thing done)

• Experience (Do they have the historical seasoning necessary for their essential job purpose?)


Next post: Management Staffing Issues …

ORGANIZATIONS

Organizations

(Q) What is the purpose of organizations?

(A) The purpose of the organization is to make strengths effective and
weaknesses irrelevant.

Each organization needs 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 that we stand for?)

Building and developing people for tomorrow (by making their
strengths effective and weaknesses irrelevant)

Next post: Management Ability Issues …