In March 2020, COVID-19 started to affect the way FQHCs provided care. Changing the perception and the way health care is provided can normally take months to years to ensure a smooth transition. As we know, FQHCs did not have that time to adapt. Come and learn from your peers! Cabarrus Rowan Community Health Center (CRCHC), located in Concord, NC, had to adapt quickly and are now one of the state's testing centers. Participants will learn how one health center changed their clinical practices in order to meet the care of their community and also ensured that staff was ready to provide care.

1. Best Practices from the Field:
How One Health Center Battles COVID-19
Margaret Currie-Coyoy,
QI Director
Ritchie Glaspy,
Population Health/
Quality Manager

2. Objectives
➢ Share our experiences, protocols, and key learnings,
since the beginning of the COVID-19 pandemic
➢ Illustrate how Safety, Partnership, and Access are the
building blocks of our successes
➢ Demonstrate how striving to be a Highly Reliable
Organization (HRO) is helping our organization move
forward so that we can continue to serve our
community

3. About Us…

4. About Us…

6. COVID-19 Timeline at CRCHC
First Draft
of COVID-
19
Protocol
First
COVID-
19 Test
COVID-
19
Process
Audit
COVID
Task Force
Tele-
health
Rapid
Mobile
Testing
February 2020: Monitoring situation,
proceeding with 2020 plans
Early
March
March
12th
Mid
March
Mid
March
May
7th
Early
April
Continuous Improvement

7. A few of the
challenges…
➢ Being new to a pandemic
➢ Change fatigue
➢ Ensuring we are meeting needs of
elderly patients, patients with
chronic diseases, children
➢ Re-thinking care while still providing
access
➢ Personnel challenges, going virtual
to protect high risk staff
➢ Loss of revenue
➢ Ongoing changes in billing
➢ Ongoing changes in legislation (HR)

8. Safety
Protocols
Audits
Education/Exerc
ises
Access
TRIAGELINE
TELEPHONICVISITS
TELEHEALTHVISITS
Partnerships
Rapid Testing
Testing Totals/Analysis
Partnership Process
• Protocols
• Audits
• Education/
Exercises
• TRIAGE LINE
• TELEPHONIC
VISITS
• TELEHEALTH
VISITS
• Rapid Testing
• Testing Totals/Analysis
• Partnership Process
The CRCHC Approach

9. And, of course, an amazing team…
• CEO
• COO
• CMO
• CFO
• DOCS
• Grants Manager
• Administrative Staff
• Billing Staff
• HR
• QI and Risk
• Dental and Medical Providers
• Behavioral Health Clinicians
• RNs, MAs, Health Coaches
• Site Coordinators
• Outreach & Enrollment Team
• Referral Staff
• Interpreters
• Facilities Manager
• Community Partners & Vendors
• Our patients and families

10. Safety

11. 5 Principles of High Reliability Organizations

12. “What could go wrong?”
The reality: Asymptomatic and symptomatic COVID-
19 patients will seek care at our clinics.
The response:
➢ How can we identify individuals with exposure?
➢ How can we keep patients and staff safe?
What ifs:
➢ What if someone comes in undetected?
➢ What if we don’t have sufficient PPE?

13. COVID-19
Protocol

14. “What ideas do you have?”
“What ideas do you have?”
➢ Mask wearing for all staff, patients,
visitors
➢ Review of upcoming appointments
to reschedule visits if medically
indicated

15. Understanding our PPE levels

16. Additional Safety Measures
➢ Daily temperature
checks
➢ Tele work for non-
essential staff
➢ Safe passage letters for
essential staff
➢ Elimination of all in-
person meetings

17. “What’s working? What’s not? Let’s Improve!”

18. COVID-19 Exercise Form

20. Access

21. 69
77
145
317
278
269
251
234
279
227
203
161
187
311
397
0
50
100
150
200
250
300
350
400
450
Mar 2-6 Mar 9-13 Mar 16-19Mar 23-27 Mar 30-
Apr 3
Apr 6-10 Apr 13-17 Apr 20-24 Apr 27-
May 1
May 4-8 May 11-
15
May 18-
22
May 25-
29
June 1-5 June 8-12
Count
COVID-19 Triage Call Volume

22. Rethinking Access: Telehealth & Telephonic

23. The Process

25. The Data

26. 52
150
387
121
1 1 7
Phone Consultation: Location
China Grove Logan McGill NRFM
Patterson Farms Salisbury HC Homeless Clinic
China Grove
14%
Logan
19%
McGill
23%
NRFM
43%
Homeless Clinic
1%
BHC Phone Consultation: Location
China Grove Logan McGill NRFM Homeless Clinic
112
44 46
21
0
20
40
60
80
100
120
Provider 1 Provider 2 Provider 3 Provider 4
BHC Phone Consultation: Provider
40
3
123
41
89
54
61 64 62
1
8
111
55
7
0
20
40
60
80
100
120
140
Count
Provider
Medical Phone Consultation: Provider

27. 1
10
11
57
13
Medical Telehealth:
Location
CRCHC HOMELESS CLINIC
CHINA GROVE
LOGAN
MCGILL
MEDICAL NRFM
40
92
45
65
2
BHC Telehealth: Location
China Grove Logan
McGill NRFM
Homeless Clinic
77
27
128
12
0
20
40
60
80
100
120
140
Provider 1 Provider 2 Provider 3 Provider 4
BHC Telehealth: Provider
6
2
11
5
13
1
4
8
3
1
26
9
3
0
5
10
15
20
25
30
Provider
1
Provider
2
Provider
3
Provider
4
Provider
5
Provider
6
Provider
7
Provider
8
Provider
9
Provider
10
Provider
11
Provider
12
Provider
13
Medical Telehealth:
Provider

28. 410
457
416
566
346
296
270
348
384 385 406
256
231
426
519
0
100
200
300
400
500
600
Count
COVID-19 Spanish Appt. Call Volume
898
982
1115
965
894
804
705
862
807
931
827
517
583
10881072
0
200
400
600
800
1000
1200
Count
COVID-19 English Appt. Call Volume

29. The Response

31. 518
453
471
404
13
6
34
43
0 100 200 300 400 500 600
Scheduled
Kept
In-Person
In-Person Kept
Telehealth
TH Kept
Phone
Phone Kept
MEDICAL Appointment Detail
64
48
8
0
31
28
17
20
0 10 20 30 40 50 60 70
Scheduled
Kept
In-Person
In-Person Kept
Telehealth
TH Kept
Phone
Phone Kept
BEHAVIORAL HEALTH Appointment Detail
34
22
34
22
0
0 5 10 15 20 25 30 35 40
Total Scheduled
Total Kept
In-Person
In-Person Kept
Telehealth
DENTAL Appointment Detail
COVID-19
Appointment
Detail
Analysis

32. COVID-19 Operational
Adjustments & Monthly Goals
• Face 2 Face Encounters:
• 1,500 per month/75 per day
• Schedule at the least 110
appointments per day to account
30% No Show/Rescheduled Rate
• Virtual Encounters
• 500 per month/25 per day
• Schedule at least 35 virtual
appointments per day
• $20,000 in past A/R
• 1,943 Monthly Encounters
• $40,000 Monthly Collection
• $2,000 Per Day
• Scheduling
• Schedule 6-8 daily
• Keep 6 or more dental appointments
daily
• Increase provider’s in-person
appointments starting 6/15
• Schedule CPEs on Tuesdays,
Wednesdays, and Fridays
• Increase provider’s telehealth and
telephonic appointment volume
• Decrease Salisbury clinic operations to 1
day a week (Thursday)

33. 81%
7%
11%
80%
5%
15%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Face to Face Telehealth Phone
Appointment Forecast:
Actuals vs. Goals
Actual Goal

34. Telehealth No Show Analysis

35. Telehealth No Show Analysis

36. Culture of
Telehealth

37. “What did we learn?”
➢ Weekly COVID Task Force
➢ Data driven approach

38. 13
16
13
6
15
10
2
8
6
16
8
6
2
3 3
10
5
0
4
6
5
1 1 1
4
3 3
1
2
1
0
2
1 1
0
2
1
2
0
1
4
1
0 0 0
2
3
1
2
11
13
8
7
11
10
4
7
8
1
13
11
4
1
3
6
3
4
7
0
2
1 1 1
0
5
1
0 0 0
2
1
0
1
0
2
1
0
3
0 0 0 0 0
1 1
5
1 1
0
2
4
6
8
10
12
14
16
18
3/23/2020
3/25/2020
3/27/2020
3/29/2020
3/31/2020
4/2/2020
4/4/2020
4/6/2020
4/8/2020
4/10/2020
4/12/2020
4/14/2020
4/16/2020
4/18/2020
4/20/2020
4/22/2020
4/24/2020
4/26/2020
4/28/2020
4/30/2020
5/2/2020
5/4/2020
5/6/2020
5/8/2020
5/10/2020
5/12/2020
5/14/2020
5/16/2020
5/18/2020
5/20/2020
5/22/2020
5/24/2020
5/26/2020
5/28/2020
COVID-19 Rescheduled Appt. Timeline (March 23 to May 29)
COVID R/S COVID Cancel

40. 5 Principles of High Reliability Organizations
ACCESS: TELEHEALTH & TELEPHONIC
Preoccupation
with Failure
• Rapid Change
Management
• Troubleshoot
Glossary
• Patient &
Staff
Feedback
Sensitivity to
Operations
• Not
reinventing
the wheel
• Frontline
Workers
Reluctance to
Simplify
• Billing
• Operations
• Workflows
Commitment to
Resilience
• Preliminary
Success
Outcomes
• Root
Cause
Analysis
Deference to
Expertise
• BHC
Scheduling
Coordinator
• Billing
• FD
Operations

41. Partnerships

42. Rapid COVID-19 Site Testing

43. The Process

44. Rapid Testing Roles and Responsibilities

45. Rapid Testing Roles and Responsibilities (cont.)

46. Rapid
Mobile
Testing
Supply List

47. Rapid
Mobile
Patient
Tracker

48. Rapid
Mobile
Pre-Site
Planning
Guide

49. Rapid
Mobile
Pre-Site
Planning
Guide
(cont)

51. Testing Sites

52. The Data

53. Rapid Testing Market Analysis

54. Tested Total Demographics

56. The Response

57. In the
community…
➢ Rowan Helping Ministries
➢ Cabarrus Salvation Army
➢ Concord Housing Department
➢ Rowan Health Department

58. “Let’s ask an expert.”

59. Tests Conducted - thru 6/19/20
Site Where Tested
Antigen
(LabCorp)
Antigen (Rapid)
Antibody (IGG /
IGM)
Grand Total
Total Unique
Patients
CRCHC MOBILE UNIT 56 367 0 423 341
MEDICAL CHINA GROVE 28 0 1 29 29
MEDICAL LOGAN 33 0 2 35 33
MEDICAL MCGILL 145 36 12 193 149
MEDICAL NRFM 167 171 22 360 295
Grand Total 429 574 37 1040 847
Positives - thru 6/19/20
Site Where Tested
Antigen
(LabCorp)
Antigen (Rapid)
Antibody (IGG /
IGM)
Grand Total
Total Unique
Positives
CRCHC MOBILE UNIT 0 58 0 58 52
MEDICAL CHINA GROVE 6 0 0 6 6
MEDICAL LOGAN 7 0 0 7 4
MEDICAL MCGILL 31 0 1 32 25
MEDICAL NRFM 28 38 5 71 65
EXTERNAL 21 0 1 22 22
Grand Total 93 96 7 196 174
CRCHC COVID-19 Testing Data

60. 5 Principles of High Reliability Organizations
PARTNERSHIP: RAPID MOBILE TESTING
Preoccupation
with Failure
• What if
patients
“walk-up?”
• What if we
are
overwhelmed
with demand?
Sensitivity to
Operations
• Changed
from paper
registration
to iPads
Reluctance to
Simplify
• Pre-site
visits
• Redesigned
traffic
flows
Commitment to
Resilience
• Huddles
• Amazing
teamwork
Deference to
Expertise
• Frontline
staff
• Facilities
Manager
• NC Public
Health
• Community
Partners

61. Please also e-mail us:
QUESTIONS?
Ritchie Glaspy:
RGlaspy@crchc.org
Margaret Currie-Coyoy:
mcurriecoyoy@crchc.org

62. References
• http://www.crmpo.org/
• http://app.ihi.org/FacultyDocuments/Events/Event-2491/Presentation-
10595/Document-8970/Tools_HRO_Principles.pdf
• https://www.qualitydigest.com/inside/management-column/getting-real-
rapid-cycle-pdsa-021616.html
• Weick, Karl E.; Sutcliffe, Kathleen M. (2007). Managing the Unexpected.
Hoboken, NJ: Jossey-Bass.