Community Health Center Management

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

2009-06-17T19:27:00.000-07:00

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

2009-06-14T23:42:00.000-07:00

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

2009-05-24T09:14:00.000-07:00

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

2009-05-13T20:42:00.000-07:00

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)

2009-05-10T23:36:00.000-07:00

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

2009-05-03T21:15:00.000-07:00

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

2009-04-29T21:46:00.000-07:00

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

2009-04-27T20:15:00.000-07:00

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

2009-04-24T22:45:00.000-07:00

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?

2009-04-24T07:44:00.000-07:00

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

2009-04-23T13:07:00.001-07:00

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

2009-04-18T08:43:00.000-07:00

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

2009-04-11T20:13:00.000-07:00

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

2009-04-09T07:32:00.000-07:00

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

2009-04-06T07:36:00.000-07:00

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

2009-04-03T07:27:00.000-07:00

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

2009-04-01T09:19:00.000-07:00

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

2009-03-30T07:19:00.000-07:00

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

2009-03-27T10:08:00.001-07:00

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.

2009-03-26T07:34:00.001-07:00

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.

2009-03-25T07:56:00.000-07:00

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.

2009-03-23T07:35:00.000-07:00

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.

2009-03-21T08:01:00.000-07:00

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

2009-03-17T22:25:00.001-07:00

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

2009-03-16T06:42:00.001-07:00

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

2009-03-15T08:05:00.000-07:00

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

2009-03-14T07:34:00.000-07:00

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

2009-03-13T07:31:00.000-07:00

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

2009-03-12T07:23:00.000-07:00

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

2009-03-11T07:36:00.000-07:00

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

2009-03-10T07:42:00.000-07:00

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

2009-03-09T07:23:00.000-07:00

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

2009-03-08T09:51:00.001-07:00

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:

2009-03-07T07:55:00.000-08:00

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

2009-03-06T07:20:00.001-08:00

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 -

2009-03-05T07:35:00.001-08:00

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.

2009-03-04T07:31:00.001-08:00

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 -

2009-03-03T07:25:00.001-08:00

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 –

2009-03-02T07:09:00.001-08:00

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

2009-02-28T08:05:00.001-08:00

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

2009-02-27T07:38:00.000-08:00

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

2009-02-26T07:50:00.000-08:00

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.

2009-02-25T08:53:00.000-08:00

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

2009-02-24T07:21:00.000-08:00

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

2009-02-21T06:15:00.000-08:00

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

2009-02-20T07:26:00.000-08:00

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

2009-02-19T07:13:00.001-08:00

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

2009-02-18T07:22:00.000-08:00

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

2009-02-17T07:19:00.000-08:00

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

2009-02-14T06:01:00.000-08:00

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

2009-02-13T07:30:00.000-08:00

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.

2009-02-12T07:15:00.000-08:00

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

2009-02-11T07:23:00.000-08:00

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:

2009-02-10T07:16:00.000-08:00

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”.

2009-02-09T07:34:00.000-08:00

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

2009-02-08T08:09:00.000-08:00

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”.

COMMUNITY HEALTH CENTERS – Taking Action - The Fourth Practice – c. Focus on Opportunities

2009-02-07T07:22:00.000-08:00

COMMUNITY HEALTH CENTERS – Taking Action - The Fourth Practice – c. Focus on Opportunities

We have reviewed the practice of an effective community health center Executive Director in Taking Responsibility for Communicating. Let’s look at the practice of Focusing on Opportunities:

Successful Community Health Center Executive Directors focus on opportunities rather than problems. Problems have to be taken care of; they must not be swept under the rug. But problem solving does not produce results. It prevents damage. Only exploiting opportunities produce results.

Change as Opportunity

Effective Community Health Center Executive Directors treat change as an opportunity, not as a threat. They look for changes, and ask: “How can we exploit this change as an opportunity for our community health center and its patients?”

Executive Directors also make sure that problems do not overwhelm opportunities. Effective Community Health Center Executive Directors scan these seven situations for opportunities:

1. An unexpected success or failure;
2. A gap between what is and what could be (a highly under-utilized situation in community health centers);
3. Innovations;
4, Changes in structures;
5. Demographic changes and gaps;
6. Changes in mind-set and perceptions;
7. New knowledge or new technology.

Best People on Opportunities

Effective Executive Directors and Senior Managers put their best people on opportunities rather than problems. They ask their staff to prepare two lists every two months:
A list of opportunities, and
A list of their best performing people.

Then they meld the two lists putting the best people with the best opportunities.

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

COMMUNITY HEALTH CENTERS – Taking Action - The Fourth Practice - b. Taking Responsibility for Communicating

2009-02-06T07:23:00.000-08:00

Taking Responsibility for Communicating

We have reviewed the practice of an effective community health center Executive Director to take responsibility for decisions. Now, let’s look at the practice of Taking Responsibility for Communicating:

Action Plans and Information Needs

Effective Executive Directors of Community Health Centers make sure that both their action plans and their information needs are understood.

They share their plans with, and ask for comments from, all their colleagues.

They let each person know what information they need to get the job done.

They identify the information they need, ask for it, and keep pushing until they get it.

Next post: COMMUNITY HEALTH CENTERS – Taking Action - The Fourth Practice – c. Focus on Opportunities

COMMUNITY HEALTH CENTERS – Taking Action - The Fourth Practice – a. Taking Responsibility for Decisions

2009-02-05T07:22:00.000-08:00

COMMUNITY HEALTH CENTERS – Taking Action - The Fourth Practice – a. Taking Responsibility for Decisions

Yesterday we reviewed the practice of effective community health center Executive Directors to Write an Action Plan. Today, let’s take a look at the practice of Taking Responsibility for Decisions:

When Community Health Center Executive Directors translate plans into action, they need to pay attention to:

1. Decision-making,
2. Communication,
3. Opportunities (as opposed to problems), and
4. Meetings

Let’s review one at a time: Taking Responsibility for Decisions.

A Decision Is Not Made Until

A decision has not been made until people know:
1. The name of the person accountable for its execution;
2. The deadline;
3. The names of the people who will be affected by the decision, and have to know about, understand, and approve it – or at least not be strongly opposed to it;
4. The names of the people who have to be informed of the decision, even if they are not directly affected by it.

Many community health decisions run into trouble because these bases are not covered.

Review Decisions

It is just as important to review decisions periodically, at a time agreed to in advance. That way, a poor decision can be corrected before it does significant damage. These reviews cover the results, and the assumptions, underlying the decision.

Such a review is especially important for that most crucial of decisions: hiring or promoting people.

Review Hiring Decisions

Only one-third of promotions are successful, the others are either draws or failures. Effective Community Health Center Executive Directors know this, and check up within 3-6 months.

If that decision is not as effective as expected, they don’t blame the employee. They look at themselves, and admit their mistake. The people who fail at jobs may not be the ones to blame. The Peter Principle is merely an excuse for senior managers to avoid making adult decisions and taking adult responsibility.

Community Health Center Executive Directors owe it to their community health center and to their staff not to tolerate non-performing individuals – people have a right to competent management. It may not be that employee’s fault, but that employee must be removed or reassigned.

Next post: COMMUNITY HEALTH CENTERS – Taking Action - The Fourth Practice - b. Taking Responsibility for Communicating

COMMUNITY HEALTH CENTERS - THE THIRD PRACTICE - Write an Action Plan

2009-02-04T07:18:00.001-08:00

COMMUNITY HEALTH CENTERS - THE THIRD PRACTICE - Write an Action Plan

Yesterday we reviewed the practice of effective community health center Executive Directors in asking the question: Is This the Right Thing for Our Center and Our Patients? Today, let’s take a look at the practice of Writing an Action Plan:

Write the Action Plan

Effective community health center community health center executive directors are doers; they execute. Knowledge is useless to them until it has been converted into effective behaviors and deeds. However, before springing into action, the effective community health center executive director needs to plan the course. The community health center executive director needs to think about:
1. Desired results
2. Probable restraints
3. Future revisions
4. Check-in points
5. Time expenditure implications

Define Desired Results

First, the community health center executive director defines desired results by asking:
1. What contributions should the community health center expect from me over the next 18 months?
2. What results will I commit to?
3. With what deadlines?

What Are The Restraints?

Then the community health center executive director considers the restraints on action:
1. Is this course of action ethical?
2. Is it acceptable within the organization?
3. Is it legal?
4. Is it compatible with the mission, values, and policies of the community health center?

Affirmative answers will not guarantee effective action, but violating these restraints does make it wrong and ineffectual.

Note that the action plan is a statement of intentions, not a straight jacket.

Check Results

Also, action plans need to create a system for checking the results against the expectations. Finally, the action plan has to become the basis for the community health center executive director’s time management. Time is the community health center executive director’s scarcest and most valuable resource; and, community health centers are inherently time wasters. The action plan will prove useless, unless it’s allowed to determine how the community health center executive director spends time.

Without an action plan, the community health center executive director becomes a prisoner of events. Without check-ins to re-examine the plan as events unfold, the community health center executive director has no way of knowing which events really matter, and which are only noise.

Next post: COMMUNITY HEALTH CENTERS – Taking Action - The Fourth Practice – a. Taking Responsibility for Decisions

COMMUNITY HEALTH CENTERS - Getting Needed Knowledge – Is This the Right Thing for Our Center and Our Patients?

2009-02-03T07:22:00.000-08:00

COMMUNITY HEALTH CENTERS - Getting Needed Knowledge – Is This the Right Thing for Our Center and Our Patients?

Yesterday we reviewed the first practice of an effective community health center Executive Director, by asking, and answering, the question: What needs to be done? Today, let’s take a look at the second practice, asking the question:

Is This The Right Thing For Our Center And Our Patients?

An effective community health center executive director's second practice is to ask: “is this the right thing for this community health center and its patients?”

They do not ask if it’s right for an individual board member, the network, their own status. They know that the board is an important constituency that needs to support a decision, or at least acquiesce in it, is the choice is to be effective. But effective executive directors also know a decision that is not right for the patients will ultimately not be right for any of the stakeholders.

Asking: what is right for this community health center and its patients?” does not guarantee that the right decision has been made. Even the best are prone to mistakes. Failure to ask this question guarantees the wrong decision will be made.

Next post: COMMUNITY HEALTH CENTERS - The Third Practice - Write an Action Plan

COMMUNITY HEALTH CENTERS - THE FIRST PRACTICE - GETTING NEEDED KNOWLEDGE – WHAT NEEDS TO BE DONE?

2009-02-02T07:22:00.000-08:00

COMMUNITY HEALTH CENTERS - THE FIRST PRACTICE - GETTING NEEDED KNOWLEDGE – What Needs to be Done?

What Needs to be Done?

To overcome the mistake of failing to hire an operationally strong community health center executive director, the first practice for the Board is to ask the Executive Director “what needs to be done?” The question is not “what do you want to do?” Asking what has to be done is critical for the Community Health Center Board and for the executive director’s success. Failure of the Board to ask will make a community health center executive director ineffectual.

The answer to the question “what needs to be done?” always contains more than one urgent task. However, Boards must acknowledge that effective community health center executive directors do not divide themselves. They concentrate on one task – one primary-cause-task (that, which when accomplished, will cause other events to occur).

First Things First and Second Things Not At All

If Executive Directors work best with a change of pace during their working day, they pick two tasks. Even the most seasoned executive director cannot remain effective doing more than two tasks at a time. The operating phrase is: “do first things first, and second things not at all.”

Other tasks, no matter how appealing are postponed. After completing the first priority, the effective community health center executive director re-sets priorities rather than moving to number two. The community health center executive director asks: “what needs to be done now?” this new question will result in new and different priorities.

Next Post: COMMUNITY HEALTH CENTERS - Getting Needed Knowledge – The Second Practice – Asking: Is This The Right Thing For Our Center And Our Patients?

The Tragic, Yet Avoidable, Mistake Made By Community Health Center Boards - 1. Failing To Hire an Operationally Strong Executive Director.

2009-02-01T07:47:00.000-08:00

The Tragic, Yet Avoidable, Mistake Made By Community Health Center Boards - 1. Failing To Hire an Operationally Strong Executive Director.

1. Failing to Hire an Operationally Strong Executive Director.

This single tragic mistake, and this mistake alone, is not only the Community Health Center Board’s biggest mistake, but also it will lead to the following 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.

During this next series of posts, we’ll discuss the above issue and its causative sub-issues.

Let’s begin with the number one issue: The failure of Community Health Center (CHC) Boards to hire an operationally strong executive director.

Why does this occur?
Is it really that difficult to hire a competent manager and leader?
What should a Board look for? How?
What are the factors necessary for an operationally strong Community Health Center Executive Director?

CHC Boards of Directors are often eager to hire a perceived “heavyweight” 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. CHC Executive Directors must demonstrate that they can run the CHC more effectively than the physicians, the senior staff, or the office managers – not just more effectively that their predecessor.

Easily said, but what constitutes an effective Community Health Center Executive Director?

CHC Boards need to address the following in a series of interviews, spread over several weeks, involving all Board members, senior management, and a few outsiders. This is the most important decision the Board will make.

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.

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? Is this what exists in your community health center’s Executive Director? If so, you are quite fortunate. If not, this series of posts could help your community health center and its underserved patients.

Next Post: Community Health Centers - The First Practice - Getting Needed Knowledge.

The Tragic, Yet Avoidable, Mistake Made By Community Health Center Boards - An Introduction

2009-01-31T08:32:00.000-08:00

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.

THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 7. REPEATING THE SAME MISTAKES AND EXPECTING DIFFERENT RESULTS

2009-01-30T07:21:00.000-08:00

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.

THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 6. HAMSTER WHEEL AS STRATEGY

2009-01-29T07:15:00.000-08:00

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 …

THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 5. RESISTANCE TO CHANGE AND DENIAL

2009-01-28T07:15:00.000-08:00

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

THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 4. MEANINGLESS NETWORKS

2009-01-27T07:20:00.000-08:00

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 …

THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 3. INABILITY TO EMBRACE PROVEN MANAGEMENT TECHNIQUES

2009-01-26T07:07:00.000-08:00

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 …

THE DEADLY SINS OF COMMUNITY HEALTH CENTERS - PART 2. THE TENDENCY TO CHASE THE LATEST TREND.

2009-01-25T07:39:00.000-08:00

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 …

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

2009-01-24T07:55:00.000-08:00

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?

2009-01-23T07:32:00.000-08:00

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

2009-01-22T07:19:00.000-08:00

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

2009-01-21T06:42:00.000-08:00

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

2009-01-20T07:01:00.000-08:00

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

2009-01-19T08:39:00.000-08:00

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

2009-01-18T10:28:00.000-08:00

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 …

FOCUS ON RESULTS

2009-01-17T08:32:00.000-08:00

Focus on Results

(Q) Would you please explain focusing on results?

(A) Focus on Results

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 effective steps
Completed in the effective sequence
Based on the effective strategy

Focusing on direct visible results where your contribution is relevant

Next post: The Purpose of Organizations

THE JOB OF A MANAGER

2009-01-16T07:27:00.000-08:00

The Job of the Manager

(Q) What is the job of as manager?

(A) The Job of the Manager

A manager:

Helps ordinary people become capable of extraordinary contributions to the organization by staffing from strengths with effective:
Planning
Organizing
Staffing
Directing, and
Monitoring

Next post: Focus on Results ...

THE DEVELOPMENT OF PEOPLE

2009-01-15T07:34:00.000-08:00

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 do they need to develop?
What is our placement responsibility?
Where do they really belong?

Next post: The Job of the Manager ...

PERFORMANCE AND PERFORMER APPRAISAL

2009-01-14T07:23:00.000-08:00

Performance and Performer Appraisal:

Establish targets and standards, then appraise them based on accomplishments.

What has the person done well?

What are their strengths?

Next: The Development of People ...

CONTROL OF ASSIGNMENTS

2009-01-13T07:28:00.000-08:00

Control of Assignments

Control of assignments is quite easy. For each assignment to those who report to you, or assignments you receive, ask:

• Are the effective contributors doing what is important or what is difficult?

• Are the effective contributors dealing with the issues of yesterday or tomorrow?

We’ll address effectiveness, and issues of yesterday and tomorrow, in a later post.

Next post: Performance and Performer Appraisal …

THE REPORT

2009-01-12T07:10:00.000-08:00

Continuing with the original question: "What are the tools of a manager?"...
Our prior posts included an outline of a Manager's Toolbox, and an outline of The Meeting.

This post outlines the elements to think through prior to writing a Report...

The Report:

How to make it:

readable,
understandable,
implementable, and
effective for others.

Questions:

Who is going to read it?
What do we expect them to do with it?

Tomorrow: Control of Assignments...

MEETINGS

2009-01-09T07:56:00.000-08:00

Continuing from our Managers Toolbox posting yesterday...
We have been asked for years about meetings. Instead of defending meetings,
let's outline how to approach them.

Types of meetings::

Information to others
Others to inform me
Deliberative (for decisions or opinions)

Questions to ask:

How will I use it?
Does it have a purpose?
Have I done my homework for it?

These Toolbox postings will continue.

Next: The Report...

A PRACTICE MANAGER'S TOOLBOX

2009-01-08T14:48:00.002-08:00

(Q) What are effective tools for a practice manager?
(A) There are seven tools for a practice manager’s tool box:
1. The Meeting
2. The Report
3. Control of Assignments
4, Performance and Performer Appraisal
5. Development of People
6. How to Abandon Yesterday
7. Innovation and Creativity

In further posts, we’ll elaborate on each tool.