The Tragic, Yet Avoidable, Mistake Made By Community Health Center Boards - An Introduction
An Introduction
As vital as Community Health Centers (CHCs) are, and as elemental as it may seem that hiring a competent Executive Director is crucial:
Why are so many CHCs managed by below-par Executive Directors?
What is the primary cause of the CHCs inability to achieve its mission?
Is it lack of funding?
Is it lack of providers?
How many excuses with CHC Boards tolerate until they face-up to the fact that they, the Board, have a fiduciary duty to hire an operationally strong Executive Director?
How many excuses with CHC Boards tolerate until they face-up to the fact that people have a right to competent management?
A typical medium-sized city has a population of 200,000, with 26,800 people at 200% of poverty level or below. That typical city’s community health center will serve 10,000 to 12,000 people during a calendar year. Thus leaves more than 14,000 people without basic medical care. These are the very people who are unable to afford health insurance.
The National Association of Community Health Centers (NACHCs) http://www.nachc.org/default.cfm , in its Governance materials, outlines the accountability, responsibility, and skills necessary for a community health center Executive Director:
1. Communicate with the board and management team;
2. Operationalize board policies;
3. Manage personnel and systems;
4. Allocate resources and operate within available resources;
5. Identify and resolve problems;
6. Interact with the community and providers and payers in the marketplace;
7. Respond to opportunities;
8. Plan for future events; and
9. Implement board-established long-term goals and operating plans.
The NACHC also states four areas of competency for an Executive Director:
1. Management and operations
2. Clinical program and oversight
3. Finance oversight
4. Marketing and development
These nine skills and four basic competency areas are foundational. Without these skills a community health center Executive Director is not competent to plan, organize, staff, direct, and monitor the CHC toward consistently living up to its stated mission of serving the underserved.
Why?
Why do so many community health center boards fail in this endeavor?
Why do boards seem unable to select a person with the basic competency of serving more of the underserved in its area?
Our sense is that boards may not fully appreciate the skill required by them in finding someone who can fulfill the above requirements. These volunteer Boards may not have a complete grasp of how intricate, yet basic, it really is. However, there are a few areas that, if the Executive Director is skilled, and if the CHC Board chooses an Executive Director effectively, will pave the way to success.
Just what those areas are will be the subject of our next series of posts.
Next Post: The Tragic, Yet Avoidable, Mistake Made By Community Health Center Boards - 1. Failing To Hire an Operationally Strong Executive Director.
Saturday, January 31, 2009
Friday, January 30, 2009
THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 7. REPEATING THE SAME MISTAKES AND EXPECTING DIFFERENT RESULTS
The Deadly Sins of Community Health Centers - Part 7. Repeating the Same Mistakes and Expecting Different Results
Continuing our postings on the Deadly Sins of Community Health Centers (CHCs); yesterday we discussed Part 6 – Hamster Wheel as Strategy. Today, we’ll look at the seventh sin: Repeating the Same Mistakes and Expecting Different Results.
Community Health Centers’ repeating the same mistakes and expecting different results may be either a new sin, or caused by the prior six:
Part 1 – The Lack of Urgency
Part 2 - Tendency to Chase the Latest Trend
Part 3 - Inability to Embrace Proven Management Techniques
Part 4 - Meaningless Networks
Part 5 - Resistance to Change and Denial
Part 6 - Hamster Wheel as Strategy
7. Repeating the Same Mistake and Expecting Different Results
Questions:
1. Why do Community Health Center (CHC) Boards, Executive Directors, and Senior Staff keep doing the same things, looking at the same reports, writing the same marketing plans?
2. Why don’t more CHCs succeed at serving more of the underserved?
3. Has access really been expanded over the past 35 years of CHCs existence?
4. Has it been expanded as much as is needed? Why not?
5. What are the mature leadership steps and CHC Boards and Executive Directors can take to expand that access?
The “I Love Lucy” show provides a good example of the mistakes that that many CHCs make:
One day Ricky comes home, and finds Lucy crawling around on the living room floor. When he asks what she’s doing, Lucy explains that she lost her earrings. “You lost your earrings in the living room?” asks Ricky. To which Lucy replies, “No, I lost them in the bedroom – but the light is so much better out here.”
Humorous? - Maybe… Sad? - Definitely…
Does Lucy’s behavior seem familiar?
How often have you seen it played-out at your community health center?
For many Boards, Executive Directors, and senior managers at Community Health Centers, the light is best in familiar places - repetitious reports, unfulfilled marketing plans, and unproductive meetings. They find a safe-harbor in those activities; unfortunately, there remains no improvement, no growth, and no enhanced patient care.
Boards and CHC managers distract themselves by becoming overly involved in the trivia and minutiae, often creating a complexity where none exists. They put the success of their CHC at risk, because they refuse to face, and overcome, these deadly sins:
1 – The 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
7 - Repeating the Same Mistake and Expecting Different Results
Recognizing and then overcoming these “sins” will contribute greatly toward fulfilling community health centers’ mission of serving the underserved.
Next Post: We will examine The Tragic, Yet Avoidable Mistake Made by Community Health Center Boards - An Introduction.
Continuing our postings on the Deadly Sins of Community Health Centers (CHCs); yesterday we discussed Part 6 – Hamster Wheel as Strategy. Today, we’ll look at the seventh sin: Repeating the Same Mistakes and Expecting Different Results.
Community Health Centers’ repeating the same mistakes and expecting different results may be either a new sin, or caused by the prior six:
Part 1 – The Lack of Urgency
Part 2 - Tendency to Chase the Latest Trend
Part 3 - Inability to Embrace Proven Management Techniques
Part 4 - Meaningless Networks
Part 5 - Resistance to Change and Denial
Part 6 - Hamster Wheel as Strategy
7. Repeating the Same Mistake and Expecting Different Results
Questions:
1. Why do Community Health Center (CHC) Boards, Executive Directors, and Senior Staff keep doing the same things, looking at the same reports, writing the same marketing plans?
2. Why don’t more CHCs succeed at serving more of the underserved?
3. Has access really been expanded over the past 35 years of CHCs existence?
4. Has it been expanded as much as is needed? Why not?
5. What are the mature leadership steps and CHC Boards and Executive Directors can take to expand that access?
The “I Love Lucy” show provides a good example of the mistakes that that many CHCs make:
One day Ricky comes home, and finds Lucy crawling around on the living room floor. When he asks what she’s doing, Lucy explains that she lost her earrings. “You lost your earrings in the living room?” asks Ricky. To which Lucy replies, “No, I lost them in the bedroom – but the light is so much better out here.”
Humorous? - Maybe… Sad? - Definitely…
Does Lucy’s behavior seem familiar?
How often have you seen it played-out at your community health center?
For many Boards, Executive Directors, and senior managers at Community Health Centers, the light is best in familiar places - repetitious reports, unfulfilled marketing plans, and unproductive meetings. They find a safe-harbor in those activities; unfortunately, there remains no improvement, no growth, and no enhanced patient care.
Boards and CHC managers distract themselves by becoming overly involved in the trivia and minutiae, often creating a complexity where none exists. They put the success of their CHC at risk, because they refuse to face, and overcome, these deadly sins:
1 – The 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
7 - Repeating the Same Mistake and Expecting Different Results
Recognizing and then overcoming these “sins” will contribute greatly toward fulfilling community health centers’ mission of serving the underserved.
Next Post: We will examine The Tragic, Yet Avoidable Mistake Made by Community Health Center Boards - An Introduction.
Thursday, January 29, 2009
THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 6. HAMSTER WHEEL AS STRATEGY
The Deadly Sins of Community Health Centers - Part 6. Hamster Wheel as Strategy.
Continuing our postings on the Deadly Sins of Community Health Centers (CHCs); yesterday we discussed Part 5 – Resistance to change and denial. Today, we’ll look at the sixth sin: Hamster Wheel as Strategy.
6. Hamster Wheel as Strategy
In the face of consistently declining reimbursements and disappearing grants, many community health centers adopt the "hamster wheel" strategy in which the centers run harder and faster to stay in the same place financially. Ultimately, there is a limit to how much can be done before that community health center and patient care begin to suffer.
Since personnel is policy, and since policy decisions, by the Board and implemented through the Executive Director, are the drivers of the operations and success of the community health center, effective people decisions are critical:
Selected suggestions for CHC Boards and Executive Directors:
1. If you put a provider or staff member into a job, and they do not perform, you have made a mistake. Don’t blame the person. Do not invoke the “Peter Principle”. Stop complaining, and fix your mistake.
2. Every employee has the right to a competent manager and leader. It is the Executive Director’s duty to make sure that the responsible people in their community health center perform (contribute effectively).
3. Of all the decisions an Executive Director makes, none are so important as their decisions about people. Those decisions determine the performance capacity of the CHC. It is your duty to make those decisions well.
4. The single “don’t”: Don’t give new people major assignments. This will only compound the risks. Put hat person into an established position where the expectations are known, and help is available.
5. Give major assignments to someone whose behavior and habits have been observed by you. Give those assignments to someone who has earned trust and credibility within the community health center. Make sure you know that person by performance, not by reputation.
The decision steps are few and basic:
1. Think through the assignment.
2. Look at a number of potentially qualifies people.
3. Think hard about how to look at these candidates.
4. Discuss each of the candidates with several people who have worked with them.
5. Make sure that person understands the job.
While community health centers cannot afford to ignore the political and market forces impacting them, they would be wise to focus their energy and resources on those internal forces which inhibit progress, and which they can control. Then they will be able to compete successfully in today's changing health care marketplace. Then they can continue serving the underserved.
Next post: The Deadly Sins of Community Health Centers: Part 7 - Repeating the Same Mistake and Expecting Different Results …
Continuing our postings on the Deadly Sins of Community Health Centers (CHCs); yesterday we discussed Part 5 – Resistance to change and denial. Today, we’ll look at the sixth sin: Hamster Wheel as Strategy.
6. Hamster Wheel as Strategy
In the face of consistently declining reimbursements and disappearing grants, many community health centers adopt the "hamster wheel" strategy in which the centers run harder and faster to stay in the same place financially. Ultimately, there is a limit to how much can be done before that community health center and patient care begin to suffer.
Since personnel is policy, and since policy decisions, by the Board and implemented through the Executive Director, are the drivers of the operations and success of the community health center, effective people decisions are critical:
Selected suggestions for CHC Boards and Executive Directors:
1. If you put a provider or staff member into a job, and they do not perform, you have made a mistake. Don’t blame the person. Do not invoke the “Peter Principle”. Stop complaining, and fix your mistake.
2. Every employee has the right to a competent manager and leader. It is the Executive Director’s duty to make sure that the responsible people in their community health center perform (contribute effectively).
3. Of all the decisions an Executive Director makes, none are so important as their decisions about people. Those decisions determine the performance capacity of the CHC. It is your duty to make those decisions well.
4. The single “don’t”: Don’t give new people major assignments. This will only compound the risks. Put hat person into an established position where the expectations are known, and help is available.
5. Give major assignments to someone whose behavior and habits have been observed by you. Give those assignments to someone who has earned trust and credibility within the community health center. Make sure you know that person by performance, not by reputation.
The decision steps are few and basic:
1. Think through the assignment.
2. Look at a number of potentially qualifies people.
3. Think hard about how to look at these candidates.
4. Discuss each of the candidates with several people who have worked with them.
5. Make sure that person understands the job.
While community health centers cannot afford to ignore the political and market forces impacting them, they would be wise to focus their energy and resources on those internal forces which inhibit progress, and which they can control. Then they will be able to compete successfully in today's changing health care marketplace. Then they can continue serving the underserved.
Next post: The Deadly Sins of Community Health Centers: Part 7 - Repeating the Same Mistake and Expecting Different Results …
Wednesday, January 28, 2009
THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 5. RESISTANCE TO CHANGE AND DENIAL
The Deadly Sins of Community Health Centers - Part 5. Resistance to Change and Denial
Continuing our postings on the Deadly Sins of Community Health Centers (CHCs); yesterday we discussed Part 4 – Meaningless Networks. Today, we’ll look at the fifth sin: Resistance to Change and Denial.
5. Resistance to Change and Denial
Community health centers usually exhibit resistance to change — it is part of human nature. In community health centers, resistance to change is often accompanied by a very significant and well-articulated denial, i.e., protecting themselves from perceived threats by blocking knowledge from their awareness.
As a suggestion –
Executive Directors need to make sure that problems do not overwhelm opportunities. Instead of constantly putting-out fires, effective senior management staff will take care of the pyromaniac. They will put into daily practice Pareto’s Principle of 80/20; and immediately address the 20% (or less) who set those fires.
During periods of change, rather than using those periods to solidify their position and their status, Executive Directors need to scan these seven situations for opportunities:
1. An unexpected success or failure, in their CHC, or in another CHC;
2. A gap between what is and what could be in community health;
3. Innovation in a process, technology, service, whether inside or outside the community health center field;
4. Changes in practice structure, appointment structure, market structure;
5. Demographics (often missed by CHC senior management);
6. Changes in mind-set, values, perceptions, meaning, and/or expectations; and
7. New knowledge or newly acquired knowledge.
CHC Boards, at the monthly meetings, need to ask the necessary questions, and to think through the answers they receive:
1. Is their community health center effectively serving the underserved with direct patient-care services to which they would not otherwise have access?
2. Or, is the CHC merely doing what it has done in the past? With the same results.
3. Are the answers they are receiving actually excuses?
4. Have there been direct, measureable results for the patients recently?
5. If not, why not?
6. Is the Board accepting excuses from their senior management?
7. Are they accepting the same statements and rationale they received last month, last quarter, last year?
8. Have patient access and care improved? How? Is it measurable?
9. What will the community health center Board of Directors demand from their senior management?
10. What are their expectations for improved patient services?
These are some of the things that can be done by both the Board and senior management to continue improving their service to the underserved.
Next post: The Deadly Sins of Community Health Centers: Part 6 - Hamster Wheel as Strategy
Continuing our postings on the Deadly Sins of Community Health Centers (CHCs); yesterday we discussed Part 4 – Meaningless Networks. Today, we’ll look at the fifth sin: Resistance to Change and Denial.
5. Resistance to Change and Denial
Community health centers usually exhibit resistance to change — it is part of human nature. In community health centers, resistance to change is often accompanied by a very significant and well-articulated denial, i.e., protecting themselves from perceived threats by blocking knowledge from their awareness.
As a suggestion –
Executive Directors need to make sure that problems do not overwhelm opportunities. Instead of constantly putting-out fires, effective senior management staff will take care of the pyromaniac. They will put into daily practice Pareto’s Principle of 80/20; and immediately address the 20% (or less) who set those fires.
During periods of change, rather than using those periods to solidify their position and their status, Executive Directors need to scan these seven situations for opportunities:
1. An unexpected success or failure, in their CHC, or in another CHC;
2. A gap between what is and what could be in community health;
3. Innovation in a process, technology, service, whether inside or outside the community health center field;
4. Changes in practice structure, appointment structure, market structure;
5. Demographics (often missed by CHC senior management);
6. Changes in mind-set, values, perceptions, meaning, and/or expectations; and
7. New knowledge or newly acquired knowledge.
CHC Boards, at the monthly meetings, need to ask the necessary questions, and to think through the answers they receive:
1. Is their community health center effectively serving the underserved with direct patient-care services to which they would not otherwise have access?
2. Or, is the CHC merely doing what it has done in the past? With the same results.
3. Are the answers they are receiving actually excuses?
4. Have there been direct, measureable results for the patients recently?
5. If not, why not?
6. Is the Board accepting excuses from their senior management?
7. Are they accepting the same statements and rationale they received last month, last quarter, last year?
8. Have patient access and care improved? How? Is it measurable?
9. What will the community health center Board of Directors demand from their senior management?
10. What are their expectations for improved patient services?
These are some of the things that can be done by both the Board and senior management to continue improving their service to the underserved.
Next post: The Deadly Sins of Community Health Centers: Part 6 - Hamster Wheel as Strategy
Tuesday, January 27, 2009
THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 4. MEANINGLESS NETWORKS
The Deadly Sins Of Community Health Centers - Part 4. Meaningless Networks
In our post from yesterday, we discussed Community Health Centers’ Inability to Embrace Proven Management Techniques. Today, we’ll look at the fourth sin: Meaningless Networks.
4. Meaningless Networks
Without question, there is value and strength in numbers. It is a fundamental principle driving the development of large healthcare organizations. It is also in part the logic behind integrated delivery systems.
However, far too many community health centers create and participate in meaningless networks. Everyone in the network believes it will lead to lucrative and otherwise unobtainable contracts. Nevertheless, many of these benefits are available to the CHC - whether it is FQHC, or look-alike, with or without network affiliation.
Since CHC Boards are required to meet each month, they need to raise certain questions with their Executive Director at each meeting:
1. What is the cost-benefit effectiveness of our network affiliation?
2. What are some recent and continuing examples?
3. What is the cost-benefit effectiveness of the Executive Director and senior management’s outside activities?
4. How have the patients benefited from those efforts?
5. What have those activities cost the CHC in money, time, and lost
opportunities?
6. What other direct patient efforts are planned for the coming month?
7. What are the expected direct results?
8. What results - within what timeline?
Answers to these questions will begin to channel a center’s finite time, energy and money into relationships and alliances that genuinely strengthen medical services to help directly serve the underserved – for today and tomorrow.
Next post: The Deadly Sins of Community Health Centers: Part 5 - Resistance to Change and Denial …
In our post from yesterday, we discussed Community Health Centers’ Inability to Embrace Proven Management Techniques. Today, we’ll look at the fourth sin: Meaningless Networks.
4. Meaningless Networks
Without question, there is value and strength in numbers. It is a fundamental principle driving the development of large healthcare organizations. It is also in part the logic behind integrated delivery systems.
However, far too many community health centers create and participate in meaningless networks. Everyone in the network believes it will lead to lucrative and otherwise unobtainable contracts. Nevertheless, many of these benefits are available to the CHC - whether it is FQHC, or look-alike, with or without network affiliation.
Since CHC Boards are required to meet each month, they need to raise certain questions with their Executive Director at each meeting:
1. What is the cost-benefit effectiveness of our network affiliation?
2. What are some recent and continuing examples?
3. What is the cost-benefit effectiveness of the Executive Director and senior management’s outside activities?
4. How have the patients benefited from those efforts?
5. What have those activities cost the CHC in money, time, and lost
opportunities?
6. What other direct patient efforts are planned for the coming month?
7. What are the expected direct results?
8. What results - within what timeline?
Answers to these questions will begin to channel a center’s finite time, energy and money into relationships and alliances that genuinely strengthen medical services to help directly serve the underserved – for today and tomorrow.
Next post: The Deadly Sins of Community Health Centers: Part 5 - Resistance to Change and Denial …
Monday, January 26, 2009
THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 3. INABILITY TO EMBRACE PROVEN MANAGEMENT TECHNIQUES
The Deadly Sins of Community Health Centers - Part 3. Inability to Embrace Proven Management Techniques.
Continuing our postings on the Deadly Sins of Community Health Centers (CHCs); yesterday we discussed Part 2 – Tendency to Chase the Latest Trend.
Today, we’ll look at the third sin: The Inability to Embrace Proven Management Techniques.
3. The Inability to Embrace Proven Management Techniques
Certain management practices, as outlined by Peter Drucker, have been universally accepted as effective in all other organizations:
Purpose: To gain needed knowledge:
1. Asking: What needs to be done?
2. Asking: What is right and effective for the organization?
Purpose: To convert that knowledge into effective action:
3. Developing action plans.
4. Taking responsibility for decisions.
5. Taking responsibility for communicating.
6. Focusing on opportunities rather than problems.
Purpose: To ensure organization-wide responsibility and accountability:
7. Running productive meetings.
8. Thinking and saying “we” rather than “I”.
Yet many community health centers still argue over whether to use them because they do not "fit" their “uniqueness”. They run on a personality-driven, top-down style. We disagree with this approach.
The practice of medicine is unique; the business of the practice of medicine is not. Effective management techniques work for community health centers as well as for any other organization.
Next post: Continuing the Deadly Sins of Community Health Centers - Part 4: Meaningless Networks …
Continuing our postings on the Deadly Sins of Community Health Centers (CHCs); yesterday we discussed Part 2 – Tendency to Chase the Latest Trend.
Today, we’ll look at the third sin: The Inability to Embrace Proven Management Techniques.
3. The Inability to Embrace Proven Management Techniques
Certain management practices, as outlined by Peter Drucker, have been universally accepted as effective in all other organizations:
Purpose: To gain needed knowledge:
1. Asking: What needs to be done?
2. Asking: What is right and effective for the organization?
Purpose: To convert that knowledge into effective action:
3. Developing action plans.
4. Taking responsibility for decisions.
5. Taking responsibility for communicating.
6. Focusing on opportunities rather than problems.
Purpose: To ensure organization-wide responsibility and accountability:
7. Running productive meetings.
8. Thinking and saying “we” rather than “I”.
Yet many community health centers still argue over whether to use them because they do not "fit" their “uniqueness”. They run on a personality-driven, top-down style. We disagree with this approach.
The practice of medicine is unique; the business of the practice of medicine is not. Effective management techniques work for community health centers as well as for any other organization.
Next post: Continuing the Deadly Sins of Community Health Centers - Part 4: Meaningless Networks …
Sunday, January 25, 2009
THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 2. THE TENDENCY TO CHASE THE LATEST TREND.
The Deadly Sins Of Community Health Centers - Part 2. Tendency to Chase the Latest Trend
Continuing our posting from yesterday on the Deadly Sins of Community Health Centers (CHCs) … Yesterday we discussed Part 1 – The Lack of Urgency. Today, we’ll look at the second sin: The Tendency to Chase the Latest Trend.
2. Tendency to chase the latest trend
Community Health Centers exhibit a marked tendency to chase the latest trend and/or available grant, irrespective of its relevancy to their mission, resources, skills, and patient needs. There is danger in trying to do what is "hot," rather than what makes sense for the center, its local service area, and its underserved patients.
The irony here is that most centers are painfully slow in implementing new management processes and structures. While many CHCs are chasing the latest trend, they are too slow to implement the changes and benefit from them.
Next Post: The Deadly Sins Of Community Health Centers - Part 3: Inability To Embrace Proven Management Techniques …
Continuing our posting from yesterday on the Deadly Sins of Community Health Centers (CHCs) … Yesterday we discussed Part 1 – The Lack of Urgency. Today, we’ll look at the second sin: The Tendency to Chase the Latest Trend.
2. Tendency to chase the latest trend
Community Health Centers exhibit a marked tendency to chase the latest trend and/or available grant, irrespective of its relevancy to their mission, resources, skills, and patient needs. There is danger in trying to do what is "hot," rather than what makes sense for the center, its local service area, and its underserved patients.
The irony here is that most centers are painfully slow in implementing new management processes and structures. While many CHCs are chasing the latest trend, they are too slow to implement the changes and benefit from them.
Next Post: The Deadly Sins Of Community Health Centers - Part 3: Inability To Embrace Proven Management Techniques …
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