2. Arroyo Fresco
Community Health Center:
Enhancing the FOCUS model
Study Group B members:
Beatrice Toyin Babalola
Ibrahima Diallo
Shalini Gund
Shereese Maynard
CJ Spann
3. Arroyo Fresco
Mission
To serve all patients; regardless of their ability to pay;
against tight fiscal environments at federal, state, and local
level, including:
- an increasing percentage of uninsured patients (one of the highest in the
United States),
- no growth in federal grant payments for uninsured patients, and
- cutbacks in Medicaid eligibility at the state level
Vision
Through our leadership in health care design and delivery, education and
training, and community involvement, the people of western Arizona will
become the healthiest in the state.
Values
◦ Respect
◦ Trust
◦ Relationship
◦ Performance
◦ Accountability
4. FOCUS model
Financial performance
Serve all patients regardless of their ability to pay
Organizational learning
Address workforce gaps
Clinical Excellence
◦ Low incidence of prevention & screening
◦ Higher incidence of communicable disease
Utilization
Mechanisms to provide specialty care and unmet service
needs
Satisfaction
◦ Staff recruitment & retention challenges
◦ Maintain/enhance relationships with patients,
community, & external partners
5. Arroyo Current Patient Data
Fewer patients are
reporting they could
not get an appointment
when wanted,
however, La Paz &
Yuma are still at
almost 10% each.
Unfortunately, wait
times increased from
the previous year,
showing little
improvement over the
past 4 years
6. Arroyo Current Patient Data
Fewer patients are
reporting their
medications were not
explained so they could
understand them,
however, all counties
have room for
improvement.
A large percentage
(30% on average) of
patients feel as
though their
questions are not
answered.
7. Arroyo Current Employee
Satisfaction
Daily huddles to determine staffing
needs
Workforce mirrors community
demographics
Staff members meet with supervisors
twice annually
STAR and Superstar recognition
Teamwork culture
Succession plans evaluated annually
Employee training and development
Decreased staff turnover
8. Arroyo Current Clinical Data
•Results for community confidence show
improving results over the last three years
among users and nonusers in all counties,
with overall, pediatric, and senior care
performance that is the best in the state for
2005.
•These results demonstrate AF’s progress
toward the key customer and stakeholder
requirement that AF have a reputation as a
high-quality health center.
9. Arroyo Current Clinical Data
In 2005, performance results for communicable diseases—
influenza and pneumococcus immunizations met Arizona’s
Healthy People 2010 goals in all three counties.
These results link to AF’s efforts to provide preventive
services and address challenges related to low incidences in
prevention and screening and high incidences of chronic
and communicable disease.
10. Arroyo Current Clinical Data
Figure 7.5-3 shows
all counties’
performance is
meeting the goal and
equal to the state
best CHC
performance levels
for office visit cycle
time.
11. Arroyo Current Clinical Data
These measures of clinical outcomes show favorable trends for
the past four to five years, with levels that approach, equal, or
surpass the state and/or national comparisons.
12. Arroyo Current Clinical Trends
Challenges
Low incidence of prevention and screening
High incidence of chronic and communicable diseases
Areas of Improvement
While results from various patient and other customer surveys
relative to satisfaction are described, results related to patient-
and other customer-perceived value, such as patient
dissatisfaction and retention, are absent.
Also lacking are results stemming from the service experience
survey or complaints from patients and other stakeholders.
Without this information, it may be difficult for AF to determine
the effectiveness of its patient complaint and relationship-
building processes.
Objectives
Increase the overall ratio of patient visits to staff
Increase the number of new patients served by developing
internal and external resources to address unmet health care
needs in the area.
14. Current Financial Performance
37% increase net income (2001 – 2005)
Significant Increases across several metrics including:
◦ Amounts collected from Accounts Receivable
◦ Development funding and Donation values
◦ Capital Appreciation
◦ Grant rates
◦ Market Share
Annual Cost Saving
◦ Purchasing Consortium
◦ Expansion of Clinical microsystems
◦ Training staff to perform the tasks that reduce the costs of audits and inspections
ROA = Relative Value Units (RVU’s)/ 1000 net asset value
◦ 15% - 19%, from 2001 to 2004
◦ 16.5% 2004 ROA; Under benchmarks of 18%-20%
Assuring Adequate Resources/ Fiscal Responsibility
◦ Zero based budgeting process linked to the five year capital and funding plans
developed during the Strategic Planning Process
◦ Consideration for productivity standards, external benchmarks and desired
technological implementations
◦ Risk Reduction: by conservatively projecting revenues, managing the timing of
revenue realization and expenses, paying careful attention to cash management,
and requiring a continuous and detailed budget-monitoring process
◦ Reduce expenditures of non-mission-critical expenses if needed
15. External Contributing Factors
◦ Medicaid
◦ Arizona’s Budget Deficit
◦ 1115 Medicaid Waiver, Brewers Healthcare
Reform Plan
◦ PPACA - threats of repeal
◦ Depleting 303 Funding
◦ Immigration
◦ Discontinuation of Medicare Part B
17. Impact
Hemorrhaging Revenue
◦ Transient Populations – Lack of accounting
Loss of Market Power
◦ Yuma County (36%) of AF annual budget
◦ La Paz County – Rural Health loss of ability to
care for Native American pop.
◦ Loss of Medicare payors – 6% of revenue
Utilization and purchasing behaviors
◦ Loss of coverage
Loss of major revenue source
Decrease quality of care
◦ Increase in demand from competitor patients
◦ Increase market share
◦ Reduction in Access, Affordability
18. Recommendations
Patient Satisfaction & Retention:
Extended appointment availability
Increase throughput/decrease wait times
Improve explanation of medications
Improve consistency of answering patient’s
questions
Improve consistency of including patient’s
preferences in care decisions
Consider implementing patient advocates, case
managers, translators, and/or social work to
help address these concerns and bridge the
gaps.
19. Recommendations
Employee Satisfaction & Retention:
◦ Re-organization to ensure consistency
◦ Convert volunteers to employees and extend
offers of employment, even if part-time,
rather than volunteer positions to potential
candidates
◦ Modification to Rising Star program to
minimize embarrassment of new employees
◦ Expand promotional checklist program
◦ Expand health benefits and decrease
employee’s cost for said benefits
20. Recommendations
Clinical Excellence:
In order to increase the screening process to prevent against the
communicable and chronic diseases we need to take the measures
below.
PEDIATRICS
Increase immunization rates for children and adolescents.
FEMALES
Increase screening rates for domestic abuse, depression,
cervical cancer, and colon cancer.
Increase in mammography services
MALES
Increase screening rates for depression
Increase screening rates for colon cancer.
OTHERS
Increase screening and support in clinical preventive areas such
as smoking cessation and obesity.
Increase immunization rates and promote influenza vaccines
Increase diabetic screening
21. Recommendations
Financial:
◦ Increase Grant Funding
◦ Developing Political Capital
◦ Mergers: Take Advantage of Economies
of Scale
◦ Partnership: CRIT Gaming Industry
◦ Lucrative Investment Practices
Endowment Portfolios/ Diversification
Investment in Securities Market
Accounts Receivable and Sweep
Accounts
22. Recommendations for
Organization
Learning
•Reduce variance in processes through
improved work flow standardization,
leadership and staff training across county
lines.
•Strengthen grants and process for work-to-
learn programs across the board to develop
work skills and competencies across county
lines
•Ensure knowledge integration into work to
increase efficiency and effectiveness
•Ensure robust processes for scheduling
appointments, responding to employees,
communicating with patients and recording of
medical incidents and errors
23. Utilization
Services offered by AF include ambulatory
medical, family and pediatric care, and dental
services. AF also offers laboratory services, x-
rays, vision and hearing screenings,
behavioral health, drug screening, and
pharmacy services. The center ensures
access to services by its patients by
managing mobile operations six days a week,
making stops at churches, schools, and
community centers. Population Growth now
makes it necessary to expand access to
surrounding counties.
24. Service Population
Current Expansion
Mohave Three New Mobile
LaPaz Sites
Yuma Lake Havasu
City
Population Saunders
Native American Tucson
Retirees
25. Internet & Expanded
Mobile Access Access &
Engagement
Standardization of
Patient
Demographic data
Tele-radiology
SATScan
Technology
integration
26. Tackling Disparities through
engagement & partnerships
Al-Anon & Alateen
Community
partnerships to American Diabetes
address and Association
overcome American Heart
disparities Association
Planned
Parenthood
27. Social Strategy &
Benefits
AF
Media Facebook page:
Argument Facebook will allow
51% of Arroyo to reach
Americans young, female
access health population and
info. On-line promote health
partnership
Women are
more likely to programs. Services
would be highlighted
contact health to include OBGYN
providers on-line services, trainings,
than men and healthy eating
Americans
LinkedIn will be
preferring useful for attracting
emailing talented staff
physician↑3.6%
28. Security
Current Standard New Standard
Password protection Expanded duties for
HIPAA compliance the CIO to include
training for staff disciplinary action
protocols & oversight
EHR limited access
of compliance program
System upgrades to
increase protection of
PHI: EHR
interoperability
Annual Risk Analysis
to detect breach
vulnerabilities
Adoption of a
Notification policy
29. References
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Editor's Notes
Welcome. Thank you for this opportunity to present Team B’s proposed improvements to Arroyo-Fresco Community Health Center’s Organizational Strategy.
As you are aware, Team B was contracted to evaluate the existing organizational strategy of Arroyo Fresco Community Health Center then, based on the evaluation, propose alternate organizational strategy(ies). Each member of Team B has contributed to this effort. The names of all team members are listed on the screen. As I read their names, I ask they come forward so you can associate their face with their name. Also, should you have questions after the presentation or after the conclusion of your meeting, all team members will be available in the foyer to answer questions or engage in follow up conversation.
As all of you are aware, Arroyo Fresco (AF) is a non-profit, community-owned healthcare organization serving western Arizona. Their primary purpose, as reflected in their company Mission is to provide high-quality health primary care and preventive services regardless of a patient’s ability to pay. Further, they provide enabling services including transportation, translation, case management, health education, and home visitation. These enabling services increase patient access to care, thereby increasing compliance and monitoring. These services combine to improve the overall health of the residents of the counties served by AF. The three counties serviced by AF in western Arizona are remote, rural areas with sparse populations. Thus, if not for AF, the patients in these area would likely be in much poorer health.The Mission of AF further reinforces and operationalizes its Vision. Clearly, community involvement is important to the success of AF. The guarantee of providing services regardless of the patient’s ability to pay promotes preventive treatments and early access to healthcare, thus hopefully intervening before a disease process or illness progresses further. The early intervention, in turn, decreases hospital admissions and/or decreases lengths of stay. These all contribute to healthier citizens within the state of Arizona.AF utilizes five key values as the basis its Mission, Vision, and daily operations. The first value is respect and their clinicians recognize the worth and respect the dignity of every individual. The second value is trust, which is reflected in individual and corporate integrity in all aspects of their operations. The third key value is strong relationship which is the result of honoring each patient’s and their family’s values, preferences, and goals. The fourth key value of AF is performance, as reflected by their commitment to continuous process improvement and innovation. Finally, the last value on which AF focuses is accountability as evidenced by their open review of results achieved.
Arroyo Fresco utilizes its annual Strategic Planning process to identify its strategic challenges then aligns them with five key performance areas in the FOCUS framework. The FOCUS framework is used to create an environment of sustainability and performance improvement. First is a focus on financial performance. Because AF guarantees services regardless of ability to pay, they must develop innovate ways in which additional services are provided and can be leveraged. The next area of FOCUS is that of Organizational Learning. This is a process by which processes are evaluated regularly in an attempt to develop best practices and then utilize data and information from these practices for comparison to existing industry benchmarks. This iterative process provides learning and development at both the individual as well as the organizational level. Clinical Excellence is the third key performance area. The healthcare industry and the processes associated with it change at a rapid pace. The ability of an organization to adapt to said changes is critical for their sustained success. Utilization of the healthcare services is also crucial to organizational success. If services are offered , but not utilized, they are ineffective. Therefore, AF strives to maximize the utilization of their services by developing partnerships and/or contractual agreements with clinicians, facilities, and organizations to make the services more accessible to a larger population of patients. Finally, Satisfaction is the fifth strategic challenge which AF includes in reviewing their strategic plan. This includes satisfaction of patients, and their families, with the care they receive and the intent to retain their loyalty. However, satisfaction also applies to employees and volunteers. AF works diligently to ensure career ladders, skill development, and succession plans as a means to recruit new employees as well as retaining current employees and volunteers.
Arroyo Fresco has made many strides to improve patient satisfaction between 2002 and 2005. And the results do show these improvements. However, there are still opportunities for improvement. For example, each county has decreased the percentage of patients reporting they could not get an appointment when they wanted. In fact, all counties are now reporting percentages less the national norm for each of the past two years. Despite this improvement, LaPaz and Yuma counties are still at approximately ten percent each. In LaPaz county, the only facility currently only provides services four days a week and many of the rural residents receive care via the van service, which also have limited appointment availability. These limitations likely contribute to the scheduling challenges. Another measure relative to patient satisfaction is the wait time to see a clinician after arrival and check in. While moderate improvements have been appreciated relative to these wait times between 2002 and 2005, approximately twenty percent of patients, on average, still perceive their wait time to be too long. While this average is slightly below the national norm, it is nearly double that of the state-best community health center. One of the critical benchmarks Team B evaluated was the ability to increase throughput, thereby decreasing wait times.
A key element to patient improvement is the patient’s understanding of their medication, what it does, what the potential side effects are, etc. This understanding, in turn, has the potential to have a positive or negative impact on the patient’s status. Nearly ten percent of AF’s patients still report that their medications were not explained to them in a manner they could understand. This is approximately on par with the state-best CHC, and significantly better than the national norm. However, because of the potential impact to the patient’s condition, Team B would recommend continued improvement in this area. One of the most concerning of Team B’s findings was that nearly thirty-five percent, on average, of AF’s patients did not feel as though their questions were answered. This is disturbing in that patients should not be confused about their healthcare. They should be able to ask questions of their healthcare providers and have them explained at a level the patient can understand. Patients making uninformed decisions regarding their medical care also has the potential to have a negative impactin both the short and long term of their care. Team B strongly recommends AF focusing on this issue. Perhaps the integration of a case manager, social worker, or translator could improve the patient’s experience as it relates to having their questions answered.
Overall, Arroyo Fresco is doing many things to ensure employees are satisfied. Clearly the culture at AF is focused on teamwork. This contributes to employee satisfaction as well as employee engagement and interaction. Further, the fact that the workforce mirrors the demographics of its surrounding communities is a patient as well as an employee satisfier. This allows for patients and their clinicians to really connect and interact comfortably. The STAR and Superstar recognition programs are important mechanisms by which employees are noticed for performing well as it relates to at least one of the key values. Even the minor operational event of a daily huddle to determine the needs of the patients for that shift, as well as the staffing needs can be invaluable – warding off problems and frustration before they occur. Additionally, AF’s commitment to employee training and development is paramount. For companies to succeed at an organizational level, they need for employees to succeed at a personal level. Thus, skill development and expansion, establishment of a career ladder, familiarity with promotional requirements, are vital. Also important are the biannual meetings between employees and their supervisor. This allows employees and supervisors to ensure they are on the same page and the employee is progressing as expected. It also allows for timely correction should their be a performance issue. AF’s commitment and focus on employee satisfaction & retention is evidenced by the recent decrease in staff turnover.
Arroyo Fresco’s customers, as well as their stakeholders take pride in their reputation as a high-quality health center. Further, their leadership wants to maintain said reputation. Therefore, they regularly solicit the community for feedback regarding their performance. It is important to note that the trends in the three graphs on the screen all show positive trends relative to confidence in the quality of care. This is true of users and non-users of the healthcare system. Further, one the key focuses of AF’s program is Women’s Health, especially in Yuma county. The data reflected in Figure 7.2-8b shows both users and non-users of the system have increasing confidence in the quality of care for Women’s and Children’s health, with users of the system approaching one hundred percent confidence in the care this special patient population receives. Because the patients within AF’s population tend to be in poorer health than the general population, there is particular concern about chronic diseases. In addition, the AF patient population is comprised of aging patients. Figure 7.2-8c indicates positive trends for both chronic disease and elderly patients, among users as well as non-users of the healthcare system.
The case study presented to Team B indicated AF’s patient population has high incidence of communicable diseases. The percentage of patients receiving the influenza immunization, as indicated in Figure 7.1-4a, has improved every year since 1999. Further the percentage of population receiving the flu vaccination has exceeded the state BFRSS each year since 2002. Finally, the influenza immunizations compliance in 2005 met Arizona’s Healthy People 2010 Goals in all three counties serviced by Arroyo Fresco. Similar to the results for the influenza immunizations, the percentage of AF patients receiving the pneumococcus immunization has improved in each of the three counties has increased every year, which significant improvements between years 2002 and 2003. For years 2003 – 2005, the average pneumococcus immunization percentage for the three counties AF serves has exceeded the state BRFSS. Finally, the pneumococcusimmunizations compliance in 2005 met Arizona’s Healthy People 2010 Goals in all three counties served by Arroyo Fresco.
Another measure of patient satisfaction is the cycle time associated with an office visit for a healthcare provider. Figure 7.5-3 clearly indicates improvement in each county between 2002 and 2005. In 2002, the cycle time for an office visit in Yuma and Mohave counties was twice that of the 30-minute goal. While LaPaz county was slightly better than the other two counties in 2002, the cycle time there was still significantly longer than the goal. In 2005, all three counties had achieved the office visit cycle time goal of thirty minutes, which matched the state-best Community Health Center. This is dramatic improvement, which shows Arroyo Fresco’s commitment and dedication to these improvement processes – literally cutting cycle time in half. An amazing improvement.
Figures 7-3.1a through 7.1-4a display multiple measures related to clinical outcomes, all of which has positive trends. Further, all of the graphs indicate the patients in the three counties served by AF have made dramatic improvements with screening and immunizations, both vital pieces of preventive healthcare, that can positively impact patient outcomes.
To summarize the current clinical trends related to AF’s patient population, there were two significant challenges: 1) Low incidence of prevention as well as screening and 2) High incidence of chronic and communicable diseases. These two challenges are deeply concerning given the potential implication of the combination of the two could result in epidemic outbreaks. Further, Team B identified two particular areas of improvement related to the current clinical trends. The feedback received from surveys and documented complaints does not contain information relative to patient- and/or customer-perceived value nor does it contain information regarding patient satisfaction and/or retention. Additionally, the feedback from the current mechanisms does not provide insight related to service patients and/or stakeholders received. This information is critical to determine the efficacy of the complaint and/or relation-ship building processes.From this evaluation, Team B established two objectives. The first objective was to increase the overall ratio of patient visits to staff. The second objective identified by Team B was to increase the number of new patients served by AF. The plan to accomplish this increase is to expand both internal and external resources in order to address those areas of healthcare needs which are not met by the current facilities and clinicians.
The graphic on the screen shows a very basic representation of the budget for the Arroyo Fresco Community Health Center for 2005. As you can see, the net income is approximately $6.7 million. Further, the largest component of the operative revenue comes from Medicaid (33%), followed by grants, donations, and annuities (25%), then by 303 Grant funding (22%) rounding out the top-three sources. It is also interesting to note private insurance, self-pay, and Medicare each only contribute six percent of the operating revenue each. This in a very unconventional distribution of the sources of the operating revenue. This distribution clearly reflects how large the underserved populations in western Arizona are, as well as how Arroyo Fresco attempts to overcome this deficiency.
Currently, Arroyo Fresco Community Health Center is performing well financially. However, as with everything, there is always room for improvement. Let’s briefly review the current status. In the years 2001 through 2005, the net income increased by thirty-seven percent, which is significant. Additionally, the data reflects significant increases in several metrics, including the amount collected from Accounts Receivable, the value of development funding as well as donations, increases in capital appreciation, improvement in grant rates, and, finally, place in the market share. Further, AF has also made great strides relative to annual cost savings. First, they made use of the purchasing consortium. AF has also dramatically expanded the services available via the clinical microsystem. Another cost saving initiative is focused on additional training of staff members to facilitate them performing tasks that could reduce the costs associated with audits as well as inspections. The Return on Assets (ROA) is calculated by the Relative Value Units (RVU’s) per $1,000 net asset value. Since 2001, AF’s performance on this measure has been the best among state community health centers. Arroyo Fresco has made several efforts to ensure adequate resources area available and the organization maintains their fiscal responsibility. One such effort is focused around the zero-based budgeting process and the funding plans developed during the Strategic Planning Process. Further, AF regularly evaluates their productivity standards, compares them to current benchmarks, and considers if technological improvements could be implemented. Another mechanism by which Arroyo Fresco maintains their fiscal responsibility is by careful monitoring of case management as well as conservative revenue projection. The combination of these processes allows AF to manage the timing of the realizations of both revenue and expenses. This process reduces overall financial risk. Finally, AF also reduces spending related to non-critical expenses when necessary.
[Need help with the Notes for this slide]There are several external factors which contribute to Arroyo Fresco’s success and profitability. First, is the instability of Medicaid and the poor payment schedule associated with the services provided to patients in the Medicaid program. One must consider the large percentage of AF patients who are currently enrolled in the Medicaid program. Additionally, the budget deficit in the state of Arizona contributes to the challenges associated with AF’s mission. While AF is committed to providing healthcare services regardless of a patient’s ability to pay, this becomes increasingly challenging as the deficit increases, thereby decreasing the amount and availability of grants and other funding sources which offset the healthcare expenses. Similarly, the depletion of 303 funding compounds this financial quandary. Because of the geographical location of AF’s facilities, immigration is a significant contributing factor. AF’s proximity to the border results in a large volume of immigrants, both documented and undocumented, who receive care at these facilities. Unfortunately, this increased volume of patients, for whom there is no reimbursement, nor will they likely be able to afford the treatment, further taxes already strained resources.
Governor Brewer has proposed a radical healthcare reform, which would dramatically impact Arroyo Fresco Community Health Center. This plan, if approved, would holistically alter the existing foundation of the AF program. Not only does the proposal eliminate services for childless adults and parents earning at least 75% FPL, it also eliminates services currently provided to undocumented aliens. Additionally the proposed reform expands copayments, modifies reimbursement rates, implements spending limits, avoids the shift to off-reservation facilities, and penalizes patients for unhealthy behaviors. This proposed reform is in direct opposition to AF’s Vision and Mission. Further, it will likely contribute to a decrease in preventive care and a regression in overall healthcare in the three-county area currently serviced by Arroyo Fresco Community Health Center.
So, what does all of this mean for Arroyo Fresco? How will AF be impacted by the proposed healthcare reform? First, because of the lack of accounting history associated with the transient populations currently receiving treatment AF, there will be a proverbial hemorrhage related to revenue. Additionally, AF will no longer have market power. This will be devastating to AF. Yuma County comprises thirty-six percent of AF’s annual budget and the majority of its residents would be affected by these changes. Further, LaPaz county, would no longer be able to provide care to their large Native American population, which is significant to the patients as well as to AF. Finally, the loss of Medicare would remove an additional six percent of the AF funding source. Additionally, there would be a significant impact to utilization of services as well as the impact to purchasing behaviors. Many patients currently receiving service from AF would no longer have coverage. This would result in calamitous loss of revenue for AF. Consequently, the decrease in revenue will likely have a negative impact on the quality of healthcare delivered. As an additional repercussion from the loss of revenue, services would be decreased, likely decreasing accessibility previously offered by the AF outreach programs. As the Domino Effect continues, the decrease in accessibility will likely result in a decline in preventive healthcare and, therefore, an associated decline in the overall health of the patients in the tri-county area. Further, as a result of losing the market share, there will be an increase in demand from competitors patients.
Team B has multiple recommendations about potential improvements to the organizational strategy. Let’s review some recommendations related to patient satisfaction and retention. Nearly ten percent, on average, of AF patients cannot obtain an appointment when they want them. Team B recommends AF consider extending appointment availability or, if extension is not feasible, perhaps shifting the availability to be more consistent with patient requests. An additional recommendation is for a focus on increased throughput to decrease wait times. As we discussed earlier, AF has already significantly improved the office visit cycle time. However, this needs to remain an active goal. Additionally, while there have been improvements between 2002 and 2005, there are still too many patients reporting their medications were not explained to them, their questions were not answered in a manner they could understand, and that their preferences were not included in decisions regarding their care. Team B strongly recommends AF consider augmenting their existing patient support with the implementation of Patient Advocates, Case Managers, Translators, and/or Social Workers who could help address these concerns and bridge the current gap between healthcare provider and patient. Ensuring the patient, and their loved ones, clearly understand their medical condition(s) as well as their medication(s), have their questions answered, and feel as though they are part of the decision-making process related to their own healthcare is a critical element to patient success.
Not only is patient satisfaction and retention important to AF, but so is employee satisfaction and retention. We discussed earlier Arroyo Fresco already makes many contributions to employee satisfaction. Thus, Team B has only minor recommendations for improvement. The first recommendation would be to reorganize such that clinical and non-clinical employees are organized in similar fashions, as opposed to the current disparity. Additionally, Team B recommends converting volunteers to employees, then extending offers of employment, rather than volunteer positions to candidates expressing interest in Arroyo Fresco. While the Rising Star is a promising program and encourages employees with more seniority to assist newer employees, it could potentially cause embarrassment to the newer employee. Thus Team B would recommend a modification to this program that they no longer wear a pin identifying them as a new employee, but implement displaying new employee pictures on a bulletin board. This would still allow seasoned employees to be familiar with the newer employees without the stigma associated with the pin, identifying the employee as a trainee or new hire. Team B also suggested expansion of the promotional checklist program. Finally, as indicated in the case study, employees rated health benefits as the most important benefit or compensation factor. As such, Team B strongly recommends Arroyo Fresco consider expanding the health benefits and decreasing the employee costs associated with said benefits. Doing so would have a meaningful impact on the majority of employees, with a virtually guaranteed improvement in employee satisfaction.
There are several opportunities for improvement as related to Clinical Excellence. The majority of these improvements involve preventive screenings and/or treatments. The primary prevention for pediatric patients is the complete and timely compliance with immunizations. These immunizations are vital for improved health throughout adolescence and into adulthood. As previously indicated, Women’s Health is a large concern in AF’s patient population, particularly in Yuma county. Special screenings included in the Women’s Health program should include those for domestic abuse, depression, as well as cervical, colon, and breast cancer. While some percentage of women in AF’s service area are having such screenings performed, it is imperative AF increase the percentage of women receiving the preventive screenings. Males should also be receiving preventive screening specific to depression and colon cancer. We discussed earlier that the patients served by Arroyo Fresco in this geographical area tend to be in poorer health than the general population. Thus, screening for contributing factors such as smoking and obesity are critical to stave off disease processes. Further, this patient population has a high incidence of diabetes, so early and regular screening is important to prevent the disease from progressing. Finally, the data show improvement in both immunization and influenza vaccination rates. However, communicable diseases still have a higher-than-normal incidence in these areas. Therefore, AF should continue to make this a priority for their patients and encourage one hundred percent of their patients to obtain all their immunizations as well as annual flu vaccinations.
Relative to the finances, Team B has several recommendations for improvement. If at all possible, Team B would recommend Arroyo Fresco increase their funding from grants. This may mean submitting more grant applications or making adjustments to process such that they qualify to receive additional grants. Further, they should develop a campaign by which they can increase capital. Another recommendation Team B suggests for AF, is to consider merging with another company or companies. When companies merge, they can take advantage of economies of scale. This affords them more leveraging power with respect to procurement and/or contractual opportunities. Similarly, Team B would recommend Arroyo Fresco partnering with the Gaming Industry. Such a partnership would result in benefits similar to that listed for the merger. Finally, Team B further recommends AF participate in investment practices which are more lucrative than their existing practices. Some examples of more lucrative investment practices would be endowment portfolios and diversification thereof, investing in the securities market, not to mention Accounts Receivables and Sweep Accounts.
Arroyo Fresco has already demonstrated their commitment to training and further education. However, respective to Organizational Learning, Team B would recommend further standardization of workflow processes, as well as expanded training for frontline staff, as well as leaders, across multiple counties. Such standardization will result in reduced variances in processes and improved output. Further, Team B would suggest the expansion of grants supporting the Work To Learn program. The Work To Learn programs develop work skills and enhance competencies throughout the tri-county area. Continuing education should be provided on a regular basis and ongoing monitoring for effectiveness would also be recommended. After completing our evaluation, our team suggests the integration of knowledge into work processes, thereby increasing work efficiency and effectiveness. However, any system enhancements will need to be efficacy based. Team B’s final recommendation relative to Organizational Learning would be to ensure the robustness of the processes for scheduling appointments, responding to employees, communicating with patients, and recording medical incidents and/or errors.
Arroyo Fresco offers a multitude of services to the patients within tri-county area. These services include ambulatory medical services, such as obstetric, gynecological, family medicine, and pediatric services. AF also provides dental services. Further services offered by AF include laboratory services, radiology services, vision screenings, hearing screening, as well as screenings for behavioral health and substance abuse. Lastly, Arroyo Fresco provides pharmacy services. In addition to the healthcare services, AF also provides enabling services related to the clinical services. In addition, AF ensures patients have access to all services offered. They do so by its service delivery network, which includes clinics and multiple service vans which make regularly scheduled stops six days a week at churches, schools, and community centers. AF further ensures access to services via partnerships and contractual relationships with facilities, agencies, and clinicians, comprising the clinical microsystem (CM).
Currently, Arroyo Fresco provides services to the Mohave, LaPaz, and Yuma counties. The largest groups within this patient population are Native Americans and retirees. Team B would recommend an expansion of the mobile services to three additional sites - Lake Havasu City, Saunders, and Tucson - in order to expand the services provided by AF. However, it is important to keep in mind that any mobile solution and/or solution proposed to ensure continued patient access will need to be adaptable in order sustain functionality as the affected population expands.
Currently, Arroyo Fresco has one main facility and three mobile sites. This does not offer enough capacity for the current growth pattern associated with their patient population. As such, Team B recommends several improvements. The first of these recommendations is the standardization of data related to the patient demographics. The second improvement Team B suggests is the implementation of Teleradiology, which is the electronic transmission of radiological images to a remote location; a patient’s diagnostic images are obtained in location ‘A’ and then sent electronically to a radiologist in location ‘B’ for interpretation and/or consultation (Hawk, 2011). The third recommendation Team B would make relative to expanded access is the integration of SATScan Technology. SatScan is a computer intensive application which can be used to detect cluster characteristics of epidemics, which in turn provides decision support to epidemiologists (Price, et.al., 2010).
I’m sure we can all agree there are currently disparities between the services available to patients. While Arroyo Fresco has made improvements to overcome such disparities, there is still room for improvement. Team B would recommend the expansion of community partnerships to help address and overcome these disparities. Some examples of relationships with could be developed and/or strengthened to assist in overcoming the disparities include Al-Anon, Alateen, the American Diabetes Association, the American Heart Association, and Planned Parenthood, to name a few. These organizations can provide a multitude of information and support to help AF provide more comprehensive information and services to their patients.
Medpage (2011) statistics show patient engagement is steadily increasing; likewise, the facility must increase social visibility to reach targeted population. Social Media is a constantly-expanding mechanism being utilized for healthcare and educational purposes alike. The majority of Americans utilize some form of electronic media to access information regarding health conditions and associated treatments. Further, an increasing amount of Americans prefer emailing their healthcare provider. One such social media tool is Facebook. Utilization of Facebook will allow Arroyo Fresco to reach an increased percentage of the young, female population to promote the programs offered by their healthcare partners. The webpage would be arranged and designed to such that the clinical services, information and training available via the website are highlighted and appealing for these young ladies. Linked In is another social media tool which has the potential to be effectively utilized to attract young professionals interested in the healthcare profession.
Compliance programs for all providers will be mandatory by 2014 according to Medicare guidelines. Also, HIPAA mandates spawn a need for increased CIO accountability. Arroyo-Fresco needs to be pro-active regarding the protection of health information. Team B recommends several new standards to improve the security associated with healthcare and the proposed mobile and telehealth services. The first of the team’s recommendations include new responsibilities for under the auspices of the Chief Information Officer. Such responsibilities would include corrective actions policies and protocols relative to information security, as well as oversight of an information security compliance policy. Further, the Information Technology department shall be responsible to enhance the IT systems to ensure the protection of Protected Health Information. The enhancements to the information system should also address any issues related to the operationalization of the Electronic Health Record. After the initial evaluation of the information telechnology infrastructure and establishment of the compliance policy, an annual risk analysis should be performed to evaluate the security of the infrastructure and the need to update the policy based on current technology trends. Finally, Team B recommends the implementation of a Notification policy.
Does anyone have any questions?On behalf of Team B, I would like to thank you for your time and attention. All of our team members will be available in the foyer after the conclusion of your meeting should any of you want to have further discussion regarding anything we presented herein. We hope you find our recommendations helpful. Should you desire additional assistance regarding how to implement any of these suggestions, our team members would be more than happy to help.Our contact information is on the handouts by the door.Thank you again for this opportunity to present our suggestions.Have a great afternoon.
